Sunday, September 29, 2019

Respecting Autonomy in Addressing Trauma and Mental Health

Mental health issues will be experienced differently by different people. Some might be so severe as to prevent us from being able to do our work or to accurately judge our ability to perform. Some might not. Not only are mental health conditions diverse, so are the circumstances, strengths, skills and vulnerabilities of those who experience them.

Although I was only recently diagnosed with PTSD, the underlying issues have undoubtedly affected me my entire career in different ways at different times. As I wrote here, the toll it took on my life was mainly personal. I remained dedicated to my career and performed competently at all times, until recently when I was unable to perform to the standard required and did the responsible thing and took some time away.

Despite what I was dealing with while engaged in the practice of law, I was no less worthy than the other lawyers around me of continuing to practice despite the fact that (with the benefit of hindsight) I'm now aware that for much or all of that time I was suffering, almost entirely without support, from an untreated mental health condition that profoundly affected me. My lack of full insight into my condition affected my well-being but did not render me incompetent or incapable of recognizing my own limits. I faithfully followed the same Rules of Professional Conduct as everyone else did. I monitored my own competence the same way all lawyers should and when I was no longer able to contribute the way I needed to, I did the responsible thing and took a break to address the issue.

That's not to say that things unfolded perfectly for me. If I had received the right kind of support and encouragement earlier, then maybe I could have suffered much less and accomplished much more. I truly wish that's what had happened for me. I'm not saying that waiting this long to finally seek help was a good thing. BUT if I had been shamed and compelled to seek help that I didn't feel ready for earlier or forced to take a break when I was perfectly capable of performing as well as everyone else, the damage would have been severe. The very harmful message would have been that my condition made me inherently less worthy of contributing (a discriminatory and shaming approach that I wrote about here, which would also have been factually wrong).

The point of me sharing the above is this: we need to support people with mental health conditions, but if we're actually going to be supportive and helpful we must aim to do so in a way that doesn't erase their autonomy, dignity and individuality.  That's not to say that there may not be times when, sadly, a mental health condition might make it impossible for us to judge our own competence accurately or continue doing what we would prefer.  Like so many other issues, this one is complicated (just like everything is, as I wrote about here). Sometimes difficult decisions will have to be made. But the default should be to give people support and proper accommodations to empower them to contribute in the way they wish to if they are capable of doing so, not to assume that they are inherently too broken to contribute (with the right supports and accommodations in place, if necessary).

I speak from experience about the impact of the more damaging approach. As a student, I sought some accommodations for what I was dealing with (an experience that I to a limited extent described here). Up to that point, I had excellent grades and consistently earned scholarships and awards. Yet, despite a proven track record of academic success, what I was greeted with when I needed support were responses that were at first highly skeptical of me (outright accusing me of dishonesty), and then, once I provided documentation regarding my need for accommodations, those responses instead became shaming and controlling. A condition of getting accommodations was a forced leave of absence from the program in one instance and forced counseling in another (for a few extra days on a paper worth very little of my grade). In the first instance, taking time off from both work and school to heal was not a luxury I could afford so I went to a different program. In the second instance, suitable counseling was also something I couldn't afford (university counseling options were not helpful for what I was dealing with and didn't feel safe or comfortable for me, and I couldn't afford appropriate private counseling. Moreover, I simply didn't feel ready for it. I wanted to focus on my studies, as I knew from past experience I was perfectly capable of doing if I could just get past that moment of needing a small accommodation). In the latter instance, I advocated for myself and declined the counseling. After much harmful back-and-forth, I was able to get them to back off from imposing that condition, but having to fight for that outcome was very damaging to me.

The experience of being coerced into options that not only were inappropriate for my circumstances but profoundly undermined my basic dignity and autonomy severely affected me. My difficulties and suffering greatly intensified and almost cost me my education. Once I managed to get past it and successfully graduate, the long-term effect was also serious. It created an intense aversion to seeking help and support for fear of experiencing shame and coercion that erased all my strengths, skills and autonomy. To this day when I come across the old emails from university administrators, I am seriously re-traumatized by reliving what I went through when being treated that way.

So here's my message from my personal experience for whatever it's worth: We have to do better. We have to offer help and support without paternalistic coercive messaging and discriminatory policies and measures. We have to make the effort to continue to recognize people's skills and strengths while offering supports that recognize and reinforce their dignity and autonomy. Otherwise, we are not helping. We are just making things worse. Speaking for myself, I don't count anyone as a friend of mental health who doesn't recognize this, no matter how much "support" they condescendingly offer.

(Note added after the fact: I wrote this about mental health in general, but it's especially important for those who have experienced trauma given the importance of empowerment and connection in healing from trauma. I would add that experiencing a mental health issue may also feel profoundly dis-empowering and disconnecting (and very traumatic in its own right) for some people if not properly supported, so I personally think the same principles would apply, although I'm no expert.)

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  



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