The mental health workers’ guide part 23

Part 27 of The Mental Health Workers' Guide considers the 'us and them' myth in mental health care. Don't forget that you can download the podcasts and video clips that accompany this series here.

There is no ‘us and them’

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In spite of having had my own issues in the past I began my nurse training with a very superficial mindset. I believed, without even thinking about it, that there were essentially two types of people in the world. There were ‘the mentally healthy’ and then there were ‘the mentally unhealthy’.

As a student nurse I believed myself (very arrogantly, I might add) to be one of ‘the mentally healthy’. I thought that people were born to mental health or to mental ill health and that the work of mental health services was to protect ‘the mentally unhealthy’ from themselves either by medication or by more social methods.

I’m embarrassed to acknowledge that my training did nothing to challenge that idea. Fortunately things have moved on and continue to do so but the student nurse training of 20 years ago was very definitely saturated by an ‘us and them’ ideology.

Of course, nobody ever came out and said it quite so bluntly, so starkly as I just did but there were plenty of references to ‘chronic illness’ and ‘irrecoverable’ conditions to illustrate the point just as clearly. Nowhere was this more obvious than during placements on the wards where people were described as ‘revolving door’ or ‘long stay material’ as though their very essence was illness and nothing more. I’m ashamed to say that for my first few years after qualifying I bought into this mindset completely along with all its negative (and essentially false) assumptions about incurable psychotic illnesses and irredeemable personality disorders.

I was glad to be one of ‘us’.

Then an interesting thing happened. I moved away from my first job on an acute psychiatric ward serving a large, deprived inner city area to my home town and began to meet up with old friends – many of whom I hadn’t seen for years. Around half a dozen of us met up for a meal in a local pub one night. It was a way to reintroduce myself to my old mates. And we had a good time swapping stories of our schooldays and catching up on the events of the intervening years. That was when it first began to become clear to me that there really is no ‘us and them’.

Of the six of us sat around that pub table five were taking anti-depressants. Every single one of my old friends had been prescribed pills to make them feel better. But they were my old mates. They were my best friends. They definitely weren’t to be considered as ‘them’.

That was the beginning of a mental journey that led me to rethink my old assumptions about mental health and illness. I needed to work out what was different between my old school friends and me. It surely wasn’t simple biology as I’d been taught. They couldn’t all have ‘the depression gene’ (whatever that is).

Finally it dawned on me. The difference isn’t just biology, although that can have a part to play. Biology is not the complete answer. It’s not the complete answer by a very long way. Attitude, social situation, environment and general coping style are just as important – arguably very much more so. This matters.

Once we acknowledge the impact of social skills, environment, opportunity, coping methods and psychological style we begin to see that given the right life chances people can be far more than they might appear. Our own assumptions about ‘them’ keep people from overcoming their problems by limiting those opportunities. It’s truly amazing what people can do when we treat them like ‘us’.

There really is no such thing as ‘us and them’.