“There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.”
I’ve recently found myself in a few mental health crises that have really ended up resulting in a lot of instances where I’ve felt like I have been treat poorly by psychiatric professionals and I’ve found myself remembering when I used to help an Inspector of my local Police force and a member of staff from the mental health NHS Trust in my area, to deliver mental health training to new Police recruits. Aside from it filling me with hope that I could shape the understanding these Officers had and therefore the quality of their response to anyone with a mental illness, it also taught me the importance of do’s and don’ts in the mental health world. And, more specifically, the importance of those do’s and don’ts coming from someone with actual personal experience of being shown these various responses or given such treatment in relevant situations, because in psychiatric care, experience could/should mean a whole lot more than a certificate…
In the Police training sessions, I would have never claimed that my input and contribution to it was any more important than that of the Inspector and NHS staff member, but the piece I did feel was almost essential was around the sheer, enormous impact a Police Officer – or anyone interacting with an abuse survivor – could have on the person’s mental health. I explained that to illustrate just how monumental it can be, that it was like speaking to someone about to jump from a height; you have the potential/opportunity to either talk them down to safety, or provide them with even more motivation and influence to jump. And this sounds dramatic but it’s honestly so realistic and practical too. I mean, there was one instance where I was literally about to make a suicide attempt and called my local Crisis Team to say that I didn’t actually want to do it, but that I needed help talking myself out of it because I felt that I didn’t have the power to do it by myself. Their response – that included branding me an ‘attention-seeker’ – just filled me with more reason to continue with my attempt and within hours, I was in the resuscitation department of A&E!
One of the important factors to keep in mind here, is that recognising your potential impact on an abuse survivor isn’t about absorbing that person of any responsibility in how they respond to anything you say or do. This, was actually something I’ve had to really learn and accept over the years of my ill mental health because I used to regularly shirk the blame if I were to self-harm or attempt suicide influenced by another person’s actions – or inactions. I would be filled with resentment with the utter belief and conviction that even though it wasn’t my fault, I was the only one dealing with the consequences of whatever I had done in response to the interaction with that other person. It left me feeling incredibly lonely, unsupported, and very reluctant to reach out to anyone at all, out of fear that they would “make me feel worse,” and then leave me alone to deal with the repercussions and the aftermath of it.
Now, if you’re going to acknowledge the influence you can have on an abuse survivor’s mental health and general wellbeing, it’s important that you understand why this is the case. It’s important that you appreciate that someone who has experienced abuse of any sort, can develop some incredibly difficult, complex, and upsetting thought processes around an enormous variety of relationships that might end up including all the people who actually mean the most to them. When your safety and basic rights are suddenly being controlled by another person, it can be challenging to find any sort of motivation to trust or rely on anyone else. It’s like; ‘if that person can betray and hurt me, why should I make myself vulnerable and grant anyone else the opportunity to go and do the exact same thing to me?’
With abuse – again, of any sort – there can be a huge focus on validation and survivors might often experience an intense and desperate need to have all their thoughts and feelings supported and valued. This is typically motivated by the fact that an abuser can have a certain ‘skill’ at demeaning and dismissing the survivor’s opinions, actions, and emotions. That the abuser can encourage the idea that their victim is somewhat unimportant and undeserving of anything positive, happy, and safe by instilling a sense of guilt and the notion that the survivor is somehow responsible or blameworthy for what is being done to them. And so, if an abuse survivor is confiding and trusting in you, valuing an interaction with you, and generally regarding you with respect; it can be beneficial if you show appreciation for it. Doing so, can result in a survivor feeling encouraged and supported in engaging in other interactions that could be incredibly helpful for their mental health and wellbeing.
1. Allow the survivor to use – or facilitate it for them – whatever they find most helpful to motivate and encourage their interaction with you, whether that means writing some notes or a letter or needing some sort of background noise e.g., the TV or music. Doing what you can to make things easier for the survivor will likely instil a sense of comfort and reassurance and could influence respect and appreciation towards you.
2. Provide a safe and positive environment for the interaction by instilling a sense of control in the survivor for them to have some sort of dictation as to the circumstances, the location, and the time and date of the interaction. This can encourage a level of calm and less pressure or stress on them to talk so that they are more willing to interact in an open and honest way that proves to be therapeutic and productive for their mental health recovery.
3. Illustrate some sort of empathy, understanding, and respect for their abusive and traumatic experiences in a way that will encourage a more positive and helpful attitude and opinion of you which will aid in building a therapeutic relationship that instils a level of confidence, respect, and trust in each other. Doing this, gives the potential to improve the likeliness and practicality of the survivor confiding in you and showing some sort of reliance on your care and support.
4. Maintain a level of control over the survivor’s communication and relationships with others to ensure no poor influence of attitudes and behaviours that contradict the healthy, safe, and positive ones that you’d like to encourage. Abuse can cause a belief that you’re completely alone in your experiences, which can make talking to others with similar traumas feel like a wise idea. Even if those people are unwell and encouraging self-harm or other negative coping mechanisms.
5. Recognise each survivor you interact with as an individual who is completely separate from anyone else – even if they have almost identical or similar experiences/abuse stories – yet ensure there’s a level of continuity in the respect and equality you show all those you speak with. Using the ditty ‘treat others how you would like to be treat’ should be a key philosophy in the treatment and care provided to abuse survivors.
In recent years, ‘trauma-informed care’ has become a bit of a hot word in the mental health world because more and more psychiatric professionals are recognising the significance of a person’s experiences e.g., trauma, and the role it plays if they are mentally unwell. They are finally comprehending that there are things that they (the professionals) can do when providing help, support, and care for that person; that might actually negatively interact with the person’s trauma and increase their level of risk/worsen their ‘symptoms.’ And so, there’s now a level of appreciation for the act of helping people in a way that really highlights and pays attention to the importance of how much the trauma is impacting the service user’s wellbeing because professionals are realising that doing so, can have an affect on how the person responds to their care and treatment.
When my mental health first deteriorated in 2009, there were countless instances of me being restrained by several members of hospital staff or Police and then being given sedative injections without my permission and in ways that often meant my pants were pulled down to expose the skin. At the time, I was so poorly that even I didn’t recognise these instances were triggering the memories of the rape and abuse I had experienced just two years before and that, in doing so, they were actually worsening my mental health and levels of risk/safety. And the fact that I was so unwell that I didn’t have the capacity to recognise this connection of the restraint and the trauma, really highlights the importance of services making the realisation at the earliest opportunity.
In addition to these extreme physical acts, there were also several comments made that I found triggering of memories of the abuse and which not only increased my risk of self-harm or suicide, but also massively deteriorated my thoughts and opinions on the professionals who were claiming they were trying to help and who were constantly declaring themselves to have a ‘duty of care.’ The fact that they would make such comments or ask questions like “did you love him (the person who abused me)?” left me convinced that they were untrustworthy and massively lacked even the basic levels of understanding or empathy and that they were making very little effort to correct or improve on these things.
As well as such thoughtless and upsetting comments, there was also issue with the general attitude and responses to me – particularly during mental health crises. I found that as a direct result of my traumatic experiences, I really struggled with validation. And I think that this isn’t just me – for a lot of people who have gone through sexual abuse and rape specifically – there can be a huge focus on belief and validation. Which is obviously mostly in respect of the huge concern and focus on whether you are trusted to be telling the truth when you talk about it or tell someone what has happened to you. This is actually an aspect of the abuse where I have felt quite lucky – as strange as that sounds – because I haven’t spoken to a single person who has even remotely questioned or doubted it. Even the Police! They actually said to me that when the Crown Prosecution Service (CPS) said there wasn’t enough evidence to take it to trial (my abuser obviously claimed to be innocent), they found it frustrating because they believed me, and they wanted him to pay for what he had done but there was nothing more they could do to persuade CPS to come to a different decision.
Regardless of the fact I was believed though, that importance of it and how I have felt when I was believed, has been a concept that has always stuck with me throughout my mental health journey in general. I’ve always benefited when I’ve felt validated around my thoughts, feelings, and actions because it feels like the ultimate form of respect and trust – two notions that I feel are really important in mental health. These factors can prove essential in maintaining a good, therapeutic, working relationship between professionals and service users.
It – the restraints, the sedations, the comments – all gave me the distinct impression of hypocrisy. I mean, these professionals very regularly encourage, promote, and basically preach(!) all about taking responsibility for how your behaviours affect others. They stress the importance of taking the thoughts and feelings of others into serious consideration when you’re making decisions and trying to cope with the consequences of them. Yet, somehow, some of them seem to believe themselves to be exempt from the same little lectures and societal rules/guidance and preferences.
Abuse helplines (UK based)
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