• Expert By Experience

The ‘Professional’ in Mental Health Professional

I remember sitting in a school career advisor’s office thinking about a career as a psychologist, I liked it as a subject and wanted to pursue it at university and beyond. He looked at me over his spectacles and explained how only a small percentage ever went “all the way” to become chartered psychologists. As I was leaving slightly disheartened, he stopped me. “Where are you from?” Slightly confused I answered, “well, here sir, I live near the school”. He cut me off to say “hmm, it’s just, you speak more clearly than other pupils, so I wondered if you had been somewhere else before”.

I left his office feeling confused, but it hit me that I had been speaking in my ‘posh voice’ to him. The voice I used unconsciously when wanting to come across more ‘grown-up’ and ‘professional’. I look back now and can give that act a name such as ‘code-switching’. But there was something else there, something that still follows me around now, 15 years later. The assumption I did not belong because I did something unexpected of a brown girl from East London, and I had been caught out.

Fast forward to now, and I have become that small percentage he explained away so easily back then. My role involves supporting those experiencing distress at different levels, from the individual experience to the wider social and political realm which affects us all.

I love what I do for a living, and I really enjoy the fact that I get to critically think like this every day while being challenged in my life. There are moments where I feel completely at ease, lost in the connection I have with the person opposite. But it doesn’t take long to be reminded I am occupying a very temporary space, the space of the ‘professional’.

The term professional is an adjective which comments on an individual’s skills and knowledge as well as traits and social grace. To be ‘professional’, is to carry all these expectations of society and inturn maintain the workplaces comfort and tradition. Never too loud, too abrupt, too emotional or too different from what is deemed ‘normal’ workplace behaviour.

In many respects, this is really important. Everyone deserves a space to be safe and to work to the best of their abilities. Laws consider professional standards as some form of protection against abuses of power and discrimination. But like most of these taken for granted descriptions, professionalism has a long history of policing people based on the social norms and orders of the time. For example, is professionalism applied the same across gender, race, sexuality, class or other social differences in today’s workplace, let alone 50 years ago?

The professional word, that is, the shared voice of those in a reputable field (e.g. politicians, police, academic etc.) have the influence to make some things seem truer than others, a daunting amount of power to have on our reality if it is accepted and hardly questioned.

Mental Health disciplines, in particular, have a heavier hand in maintaining the status quo by authorising what is ‘normal’ behaviour. For example, ‘Psy’ professions such as Psychology and Psychiatry, are born from white norms and interests’ overtime. They developed alongside colonisation, offering a veil of science to racist ideas and agendas. Including the diagnosis of ‘drapetomania’, a term given to some disease which caused slaves to run away, in the mid-1800s.

Mental health professions have been able to explain away injustice and inequality with scientific justifications for centuries. Seen in the increased labelling of ‘hysteria’ in women, ‘schizophrenia’ in black civil rights activists in the 1960s and currently the disproportionately higher number of black people held under the Mental Health Act in hospitals (4 times more likely than white people). Mental health services provide great support for people and communities in distress when needed but equally, they have the power to retraumatise through shutting down voices of resistance.

Over many years, people who use the services and professionals have been naming how such institutions create inequality without questioning it. This is difficult to admit, to be a health care professional is to be free of bias and discrimination. A tall order, when living in a world and reality built around biased and discriminatory assumptions. Currently, the legacy of the past has meant outdated beliefs of normality are baked in and maintained by professionalism. From the Eurocentric theories of mental health called upon to the poorly representative workforces, the beautiful symphony of stories of strength and difference are overlooked and lost.

They are the exception, not the professional rule.

I too, felt my difficulties adjusting to the norms of professionalism were some kind of internal deficit rather than questioning the goals themselves. After years of learning, working and reshaping myself just enough to pass the ideals of ‘what a good clinical psychologist looks like?’, only to inevitably get ‘caught out’ for showing the other parts of me that don’t fit, I grew defeated.

The way I spoke, looked, acted was not right. I mispronounced words I’ve only ever read, I was too ‘emotional’ and personal in my approach and I scared people (usually professionals) when having an opinion on injustice. These mannerisms echoed my upbringing, loud expressive female role models and my Punjabi fighting heritage respectively. Idealised social stories of working hard enough to progress in my career gave me the courage to keep going.

But it was only later, when meeting people with similar experiences, that I was able to see there was something deeper rooted in this narrative.

Conversations around this were often hush hush or a shared glance over when racially loaded assumptions were made by colleagues. I would sometimes be enabled enough to speak up about how different meanings of mental health and experiences exist outside professional spaces. Most often, I would be faced with attentive head nods and agreement, but the discussion ended there. Hope sank as I released an internal sigh, “of course no one would willingly rock the system which is so traditional”.

The norms remained, professionalism is synonymous for whiteness, neutrality and authority and this was hard to accept. As a reader, you too have these definitions of ‘the mental health professional’ embedded in you. For example, if at some point in the past or in the future you’ve sought support from mental health services, how would you imagine your therapist or psychiatrist to be? How would they talk? How would they dress? How would they help you understand your experiences? The images being conjured in your mind is likely different to those in mine and other readers, but undoubtedly stronger social norms are influencing our more superficial assumptions of ‘the professional’.

The most ‘me’ I could be before was with people who used the services I was part of. A supervisor who was observing me during my first year as a trainee psychologist fed back ‘do you realise you speak differently with the client? You have an accent’.

‘Damn’ I thought, ‘I’ve been caught out as the cockney I am, and that’s me being aware of the white middle-class female supervisor in the room’.

‘No, it’s not a bad thing, you come across as genuine, it’s nice to see’.

That was a new experience! Difference being celebrated? Experiences breaking down the ‘professional’ tower didn’t end there.

I distinctively remember a lecture on whiteness, not ‘BAME’ or a distant percentage being mentioned in passing, but a whole lecture dedicated to the majority. It named the reasons why race as a construct was questionable and asked those who contributed and benefited from it to speak on it, rather than be professionally colour-blind or default people of colour to ‘educate’. It was both painful and liberating and showed how it is possible to have these conversations and still be considered ‘professional’.

I began to slowly bring this into my work and training, and I wish I could say it worked and I felt I could finally be my authentic self. But no, it was hard and lonely and at times left me alienated for making the workplace unsafe. I once tried to set up a space for ‘BAME’ professionals at the service I was working at. It was after speaking to others with shared experiences but did not feel safe to explore in white spaces. But before it occurred, I faced several conversations where my motivation and sound mindedness was questioned. Ouch, but making race an issue of the POC rather than a system is not new and is not limited from white people. Whiteness as status quo was being challenged as well as the sacredness of professionalism. So, it was easier to squash me out.

In a profession set to reduce distress, acknowledging the distress it causes others and ourselves can be a painful and exposing truth. Often followed with sanitising these difficult conversations with fancy words to stay objective, a key part of the professional myth.

Professionalism is not limited to mental health disciplines but most work identities. It is important to step back and think what does it mean to me and what does it protect? Only then can we understand the effect.

From my experiences so far, the more destructive types of professionalism forced a false separation from the personal. I could not be fully myself if I were to be professional. I represented a professional voice and my intimidating feelings and walking contradictions needed to be safely boxed away. The unspoken rule of ‘leave yourself at the door’.

But unfortunately, it also boxed away the beauty which is to be human. All the diverse traits, inconsistencies, values and wisdoms which make us so. The unique position as a healthcare provider, is to balance both the personal where we celebrate the human connection with professional knowledge and support. Although, the safer expert position easily conquers the personal, what recent conversations amongst the disciplines and society in the general reveal, is to flip the script. The personal is the professional and should not be cut out.

As I continue my journey with mental health professionalism in all the ways it plays out, I look back at the gradual deconstruction of ideas which seemed so true. Although unsettling at times, it offered the clarity of the ‘type of professional’ I want to be rather than what institutions told me I should be.

Personhood is something that cannot be lost when working in an area of mental health but is easily done with damaging effects. If I face another professional in the future as a client or colleague, who is unable to sit with my social context or let go of the myth of objectivity, this is a red flag. Even if a professional speaks with an accent or does something unexpected, it is the mutual respect and curiosity for different meanings that must be the centre of a better and less oppressive mental health service experience.