Please don’t be offended, but when I’m not feeling well I don’t want your sympathy.
I know that I get depressed. But when someone is being sympathetic towards me it does feel rather like he or she is really thinking more about what they would feel like if this awful thing happened to them too. People can sometimes be really very kind to me when they are feeling sympathetic, and I appreciate that. I can see they do want me to feel better. But that warm feeling only lasts as long as I don’t do something to upset them- like shout at them or start arguing and tell them to go away. They can lose all sympathy for me then, because they really can’t feel very positive about the new angry version of me- and you need to feel ‘good’ about a person to have that warm glow of sympathy for them.
But when I lash out at others that is me too. That is how I can be when my mood gets low. I am irritable. I can remember a couple of times when I’ve seen pity in the faces of people around me. I’ve made them feel uncomfortable and embarrassed. But I don’t want your pity either thanks. Sometimes that has come with the implicit suggestion that I should be able to control myself better, even though I don’t think I can at the time.
What I want is for you to be curious about my life and who I am. To make a connection with me by trying to imagine exactly what it feels like to be me, in the situation in which I find myself. To be empathic. You don’t have to like me to feel empathy for me- you simply have to try and understand how and why I feel and behave the way that I do. To do that you have to have a conversation with me. When a health professional talks to me as though I am a real person we both experience something more meaningful. We meet as human beings- what Martin Buber called the I-Thou interaction. But the way that mental health services operate now, it sometimes feels impossible for anyone to get to know anyone else very well. You might be constantly being assessed as to your suitability for a service and be shuttled through many places for which you don’t seem to be ‘quite right’. No connection is made because it will only be broken again- the professionals retain their detachment. You become an ‘it’ to be processed in the system rather than a person, and you don’t feel helped either.
Some mental health professionals must, I am sure, think this is a better way of working because it feels safe and organized. But ultimately it is damaging and dehumanizing to everyone, both you and them. Sometimes they say they cannot help because you are not yet severely unwell enough- other times because you are simply too hard for them to cope with. Once again, they offer you their pity but nothing else.
Compassion has become a bit of a buzz word in the last couple of years, but I fear it is at risk of becoming commodified like so many other important qualities of health care. When you have compassion for someone you ‘suffer with’ them and you have a desire to relieve their suffering and help them. Personally I think its hard to have true compassion for someone unless you have time to get to know who they are and what their problems are- to have an ‘I-Thou’ rather than an ‘I-It’ encounter with them. There are few truly altruistic people who are universally good and willing to spend their lives helping everyone, regardless of what they know about them. The philosopher David Hume wrote that as humans we are characterized at best by limited generosity; especially on a Friday afternoon at 4.30.
So I fear unless you can truly make an empathic connection with a person rather than simply feel sympathy for them, the extent of your compassion will be limited. It will disappear as soon as they disappoint you. I’ve seen this happen to so many people with ‘troublesome’ behaviour with whom caring professionals have not made that important attempt to understand a life from a different perspective than their own. I have felt it from colleagues when my own behaviour was no longer within ‘acceptable’ limits for ‘depression’.
I think mental health professionals must take time to reflect on what motivates them to take up their profession. Many seem to want to maintain their ‘professional’ distance rather than get emotionally engaged and I fear this is all so easy to do in a fragmented and overburdened system like the one we now have. I have met many who retain the ‘I-it’ perspective as a cloak of (imagined) superiority. Some seem more driven by a feeling of pity for those of us who are more unfortunate in their lives, or move no further than sympathy- which I have indicated above has serious limitations. They do this rather than risk finding out that patients and service users are human too. For if you do that you have to admit the possibility that their ‘afflictions’ may not be unique to them. You may even be susceptible too- and then you would definitely not be satisfied with mere sympathy would you?
My memoir, ‘The Other Side of Silence: A psychiatrist’s memoir of depression is available in bookshops and on Amazon UK here. USA here.