Posted: Wednesday 12 October 2011
This is a guest blog from Sara, who reviews Beyond the Reach of Ladders and discusses the difficulty of talking about mental health. This is part of a series this week to highlight our campaign to end mental health stigma, Time to Change.
What makes some people turn towards danger, rather than away from it? How do you help the helper, or enable a hero figure to acknowledge vulnerability? And how does an outsider gain the acceptance and confidences of an established community unaccustomed to sharing their feelings?
These are questions addressed by psychoanalyst Dr Elizabeth Goren in Beyond the Reach of Ladders, her account of the year she spent as on-site clinician in one of New York City’s firehouses in the aftermath of 9/11.
As news of the attack on the World Trade Centre came in, Goren left her office 12 blocks away and made the decision to head closer to the disaster scene rather than attempt to get home. She wanted to offer help, thinking that the emergency services would be ‘tending to the injuries of the body, not of the heart’.
After some time offering mental health support with the Red Cross, Goren became one of a team of psychoanalysts running therapy groups within New York City Fire Department (FDNY) firehouses. The idea was for therapists to function ‘like the family doctor’ for their individual ‘house’: educating the men about the symptoms of post-traumatic stress disorder (PTSD); introducing the benefits of individual counselling; and encouraging the men to use the mental health services available to them.
The firehouse that she was assigned to hadn’t suffered the death of one of its own men in 50 years until 7 were lost in that one morning. Its members were among the first to arrive at the Trade Centre, and directly experienced the horrors of the disaster. Goren finds it hard to get the men to open up – not just because she is an outsider, or a woman – but also because they have ‘no language for their helplessness and sorrow.’
The challenge of getting therapeutic help to the firefighters is complicated by their self-image as tough and in control, reinforced by the (sometimes unwelcome) idolisation of them as heroes by the American public in the weeks after the event.
Gradually some of them begin to talk, but their emotions are often expressed as anger and frustration. Realising that group sessions are not working Goren develops her own method, which she calls ‘therapy on the run’. This is therapeutic intervention delivered on a more informal, ad-hoc basis, while hanging out near the fire trucks, snacking in the house kitchen or ducking into her storeroom ‘office’.
In these exchanges the men describe survivor guilt, confess fears of further attack, and acknowledge their anxiety, frequently triggered by the reality of the workplace and employment in emergency service. There are relationship difficulties, anger verging on violence and other symptoms of PTSD.
As media interest in the firefighters dwindles, Goren senses that the men are becoming more alienated from the public, and the desire of society to ‘move on’. But overwhelming grief does not necessarily fall into the neat stages of theory. What do you do if your response to a traumatic situation falls outside of the accepted process.
Goren includes her own feelings as part of the story: she doesn’t always have the answers, she is shocked, unprepared sometimes, unsure, incapable, tired. She is human.
As a result, this book gives an insight to the experiences of a therapist as she explores new territory in her practice during an extraordinary period working with unusual trauma.
Fear of the stigma and discrimination that many people with mental health problems still experience can prevent others from seeking help.
For many people, showing vulnerability can be at odds with their self-image and the image that they project to others, and they may be ashamed of their feelings.
How would you help someone understand that having mental health problems does not mean they are ‘weak’?
If you have opened up about problems that you have faced, what encouraged you to do so?
Sara Kirkpatrick
Years ago I had a breakdown and was sent to a psych ward. Fast forward a couple of decades later and I spoke about my experiences at a conference. I also went to speak to my MP regarding what I had witnessed and experienced at the hospital. I felt very driven to do this and speak up, as I did not want others who are suffering to have the same experiences as me; I was put into a filthy, bug infested bed. Upon waking, I imagined that the dead flies, bugs were crawling out of my body. The rubbish in my room had never been emptyied in days. Bullying nurses. Why should someone who is ill and suffering be subjected to this awfulness? Also, myexperience of psych wards, why do they always have distorted mirrors that just dis-orientate you more? Cruelty? So yes, I will always speak up for those that cannot. Magnolia
Very interesting, thanks.
I think that ‘no language for their [our] helplessness and sorrow’ is something endemic in UK and American culture, and presumable that of other former British colonies too. Centuries of ignoring people's pain, dismissing understandable reactions as "insanity" and expecting people to repress their suffering and just "get on with it" have left us emotionally illiterate.
**Possibly triggering mention of sexual abuse**
As a different example, I was talking to someone about medical tests following childhood sexual abuse. Alerts for sexual health testing usually says something along the lines of "if you are a virgin [that is the actual word used] you do not require this test". However, if someone has only ever been raped, not had sex, in any meaningful sense they are a virgin. But for medical purposes they are not. The largest proportion of people who are raped are under 16 at the time, so we're talking about a not insignificant number of people. Yet they have no word that represents their experience. They are basically dismissed.
**end triggering section**
I think we are hugely hampered by a lack of words for psychological phenomena. Perhaps as a start it would help everyone for those of us familiar with our mental health problems to have a stronger voice. Then others might recognise their own experience in our words.
Magnolia, I'm sorry about what you went through. People like you are very valuable. Thank you for helping others.
Nearly 18 per cent of the population meet the criteria for at least one common mental disorder. So the chances are we all know someone with mental health issues. In fact, the chances are that we all experience an episode of poor mental health at some point in our lives, just like we all experience poor physical health at some point in our lives.
Those firefighters, experiencing such unbelievable and unique trauma, were still unable to admit the affect it had on them.
So to try and destigmatise mental health, I would try to emphasise that mental health problems are normal, and part of the human condition, and as such, cannot be considered a weakness.
Hello Jan, it’s interesting what you say about the lack of language for expressing feelings about mental health, and I think you’re right about the importance of speaking up when we can.
One of the things I found interesting about this book was when Dr Goren decided to be more open about her own difficulties. I realise this wouldn’t be appropriate in many therapeutic relationships, but in this situation it seemed to work.
Interesting article from an unusual stance. It is difficult to explain why we can talk about somethings and not others. With 9/11 it was unexpected and a day that will always be remembered. Maybe over the years mental health has been looked at wrongly. Just a thought but I live with Bipolar Disorder but are the low 'blips' I have really just a form of Post Traumatic Stress? The fact remains I am still stigmatised in different areas of life but is it the condition or peoples judgement towards it that causes these blips.
A few days ago on world MH day I met a lady who had written a book about the impact of a family members suicide - I spoke to her about how I felt when I attempted suicide and we learnt a lot from each perspective. I explained that when you feel suicidal you are in a place even further down than feeling severely depressed, and that unless you have not felt this it is hard to understand. It wasn't a scary place either and from that low I rebuilt my life. I still live with BD but it doesn't control me. Talking is good to break the silly barriers we have between so called normality and mental illness. We are all human beings with varied and changing emotions.
Guess I am the wrong sex to be 'not a Ladder'. However, Orange is not the only Fruit, and Time to Change is not the only anti-discrimination campaign! Follow the link to find out more:
http://www.changemakers.com/morehealth/entries/wiping-out-stigma-mental-health
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