Inside a psychologist’s mind

Mental health experts peek into troubled minds and offer remedies. But how do they cope with their own anxiety? Sharon Ruth tells DH

When Deccan Herald approached me to talk about how mental health professionals take care of their own mental health, I knew where they were coming from. The Covid-19 pandemic had briefly generated interest in the mental healthcare community as we were thrown in at the deep end. The spectre of grief was unfolding at a pace we were unfamiliar with — about 69 lakh people died globally. We saw mourning families, orphaned children, and helpless widows even as we feared for our own lives.

Let me bring up a 2022 report titled ‘Psychiatric Issues Among Health Professionals’. It states that healthcare professionals at large experienced anxiety (16-41per cent), depression (14-37 per cent), and stress and post-traumatic stress disorder (18.6-56.5 per cent) during the pandemic years. Insomnia, burnout, fear, substance abuse, and suicidal thoughts were also found to be prevalent.

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Are mental health doctors affected by stress? Aren’t they trained in techniques to cope with it? Can they heal patients if they are themselves in need of healing? I think the public was always curious about us and the pandemic brought us into sharp focus.

It is not hard to see why. I am a clinical psychologist and my work may seem like a roller-coaster ride to outsiders. Let me look back on a recent day at Bangalore Medical College and Research Institute, where I work. My department assesses cases of mental retardation, mostly among children.

All in a day’s work

At 9.30 am, I rushed to an academic programme to understand the role mental health doctors can play in disaster situations, in addition to what we already do. At a quarter to 11, it was time to consult patients.

A school-going boy walked in with his mother. He had social anxiety and wasn’t performing well at school. He refused to answer any question I asked while a circle of psychology interns took notes about our exchange from a distance. I sent the mother out, but the boy did not open up. I asked a colleague to see him instead. Still, radio silence. It was frustrating.

A child on the autism spectrum was my next case. He and his mother turned up late. We take punctuality very seriously but I replaced my annoyance with a smile on my face instantly. When the child did not respond to some of my questions, the mother intervened. Overall, he was responding well to the exercises I had given. I was pleased.

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After the lunch break, I was to meet a child with Down syndrome. He did not turn up. Next up, a child with tic disorder arrived on the dot. Tics are uncontrollable and repetitive muscle movements. He was cooperative and I was happy to know he was improving. I wished he had followed the habit reversal technique I had recommended, but since he was resisting it, I revised his ‘homework’.

My last case was a boy with OCD (obsessive-compulsive disorder). He had come for a review. He wasn’t showing improvement. As a clinician, it is tiring to work with him because he doesn’t follow the exercises I write and rewrite. And being a mother of a college-going girl myself, I am concerned about his career.

That is a day in my life and it happened to be a Saturday when a good part of the world takes a break. Mental health professionals are not a ‘3 am friend’ or an agony aunt or an Instagram therapist doling out friendly advice. We are professionals. We are trained to hear you out, assess your condition, and treat you — objectively. We are hardened by science and experience to do this demanding job. We are empathetic but we also know how to set boundaries. And that’s how we absorb the roller-coaster of emotions day in,
day out.

Let’s talk

That doesn’t mean we have our own mental health all figured out. We grapple with problems, big or small, like other mortals. Anger, disgust, entitlement, despair — we aren’t immune to any emotion.

For instance, I am an anxious person and my anxiety manifests in the form of disturbed sleep and an upset stomach.

I fear ‘first days’. I lost my mobile phone on the first day of my first job, and so, when my daughter joined a pre-university, I was terrified on her first day. I fear major life events.When my husband, an IT professional, told me he needed to move to the UK for work, I was gripped by panic. I am fiercely independent but I think marriage brings dependency unknowingly and I shuddered to think of managing my life without him. It took me three months to accept that a job abroad would be good for the family.

I dodge routine health check-ups because I am scared to face the reports. When I meet children who have gone wayward because of parental negligence or otherwise, I come home keyed up, as a ‘firm parent’. When I was feeling burnt out during the first wave of Covid-19, a long call with a clinical psychologist helped. “This too shall pass,” she told me.

Anxiety also stems from the job. As that 2022 report puts it, caregivers operate with an exaggerated sense of duty combined with a sense of perfectioning. As a result, we put our patients’ needs before our own. We are scared of scrutiny and judgement by the public and our peers. What will they think of us if our patients don’t show improvement? Entanglement in medico-legal cases is another worry. I have been called to courtrooms and cross-examined for my assessment in cases of child sexual abuse. Even something as mundane as giving lectures or addressing gatherings can be highly daunting for a mental health professional.

Regrets also hang heavy. My team and I were assessing a young girl. She was experiencing constant falls and we knew stress could be the cause. After visiting us five-six times, she stopped. Next, we heard that she got admitted to another hospital and killed herself. It has been 10 years since but I can’t forget her face. In another case, a child passed away when he was under our treatment. He had come with stomach pain and we were looking for psychological reasons for it. Compassion fatigue is real, and in both cases, I asked myself, ‘Did we miss something?’

It took me weeks to move on from each of these tragedies. At such times, if there is no pressing case to attend to, I slow down my work until I feel re-energised. While I am not aware of an Indian study on the severity of disorders among mental health professionals, in my experience, it is short term. Stress, anxiety, depressive disorders, and adjustment problems — for instance, during a divorce — are common. Among full-blown disorders, I hear of substance abuse.

Help thyself

This brings us to the question: How do we help ourselves?

If I am feeling frustrated in the middle of a counselling session, I focus on my breath to relax, scribble my emotions on a piece of paper, or excuse myself from the room for two minutes. Sometimes, I hand over the case to my students and colleagues. Discussing an ongoing case with like-minded colleagues also helps.

Every doctor copes differently — with yoga, sports, and art, and in a welcome change, the culture of taking holidays is setting in. On my front, my husband, sister, and best friend are my confidants. Catching up with friends and watching movies is how I unwind. TV series can get addictive and mess with my sleep, so I stay away from them.

Doctors v/s patients

When it comes to seeking professional treatment, our community fares no better than the public. The same report talks about this dichotomy: A high proportion of health professionals neglect self-care, a phenomenon that is reflected in the old saying: “the shoemaker always wears the worst shoes”.

It is more an ego problem than taboo, I think. The first stage is denial: ‘I am a mental health doctor. How can I be seen as one with mental health problems?’ Often, mental health caregivers try to cope on their own and the journey from denial to acceptance is long and winding. And when they do start counselling, some can be rigid. ‘Don’t tell me what I need to do. I am a doctor’ is often the attitude that leads to attrition. A colleague was battling anger issues and came to me for ‘friendly advice’. He seemed receptive but he did not turn up again. Did he drop out, or did he get better? I don’t know.

Moving on. Some of the advice we give during counselling is common wisdom. Patients struggle to accept and act on it as they think the advice is too simple for the ‘catastrophic’ problem they are facing.

Sometimes, I am guilty of not practising what I preach. I encourage patients with social anxiety to ‘take risks’, that is, go out of their comfort zone. But I fear taking risks myself. For instance, as lucrative and flexible as a private practice sounds, I run away from the idea.

When it comes to bereavement, I ask individuals and families to live in the moment and grieve and not avoid looking at the photos of the people they have lost. Sometimes, I think my advice is too theoretical. Would I be able to follow the advice I give?

When my family senses that I am anxious and says ‘Don’t worry’, I often retort, saying: ‘I know what has to be done but a listening ear is all I want right now’.

But when I need help and I know it, I am receptive. I was anxious ahead of my PhD viva in 2017 and a friend put things in perspective as she told me over a call: ‘Do your best and leave the rest’. This advice is what we call ‘decatastrophising’, a form of cognitive restructuring in psychology to help us think differently about a severe negative emotion.

Watchful eyes

This doesn’t mean our mental health goes unsupervised. The head of the department has every right to check if a doctor needs counselling or medication. In a few medical college hospitals in India, psychotherapists often meet for ‘debriefing’. The primary agenda is to discuss difficulties on the job, but personal challenges also come up. Then, in the US and Germany, psychotherapists can start their practice only after going through counselling.

However, unlike routine physical check-ups, there is no such emphasis on mental health.

The upside

So now you know, we aren’t superhumans. At the same time, I must say it is quite satisfying to pull people out of the darkness. I like what someone said: ‘Therapy is like weaving a sweater’. Yes, you feel stuck and tangled up when your techniques don’t work or when patients abandon them prematurely. But if you soldier on, the final outcome is often gratifying.

In my practice, some cases have been life-affirming. I recently closed the case of a girl whose parents wanted her to study engineering after she failed to clear medicine. She felt like a failure. In her ambitions, I saw myself and the emotional baggage I carried as I struggled to get an MPhil seat in Nimhans, considered the gold standard in my field. I made it later in life. Over 20 visits in three years, I was able to reason with the girl to be flexible in life. Today, she has joined a biotechnology course in one of the best colleges in India and is doing well. She gave me a bar of chocolate to say ‘Thank you’.

A box of sweets, an artwork done with cross-stitch embroidery, and a painting of a ship sailing afar are other gifts of gratitude I have received from patients. And some don’t stop. A man, in his 70s, brings jackfruit, brinjal and ghee from his farm for my team every time he visits Bengaluru. I had assessed the cognitive defects he had developed after a heady injury.

Self-care

I have been practising for 24 years and it has been a roller-coaster ride by all means. There are days when I see couples struggling in their marriage and I come back home, feeling blessed to have a supportive husband.

Some days test my social conditioning and biases. When a man complained his wife was cheating, I didn’t believe him. She looked so naive and innocent. But he was right.

There are patients who put us on a pedestal, then there are those who don’t — a father was unhappy when I spoke to the boy his daughter was living-in with; he did not approve of the relationship.

Ideally, I would not like to see more than three new cases, or seven review cases in a day. But India has a huge shortage of trained mental professionals and psychologists like me end up attending to five-six patients a day, each lasting 45 minutes. Self-care is, thus, intrinsic to our practice.

(As told to Barkha Kumari)