Sam Dylan Finch+ Your Authors @samdylanfinch Words on mental health & being human. 🌦 Writer. Optimist. Gentle soul. 🍓 Editor @Healthline, Columnist @Greatist 🌿 Jun. 06, 2019 7 min read + Your Authors

Since sharing about Shira’s abysmal eating disorder treatment, I’ve been getting a lot of questions about whether people with mental illness should be therapists / care providers.

Let’s hash this out — because there are some things to consider that are being missed. 🧵👇🏼

Context: My friend @theshirarose experienced fatphobia in an eating disorder recovery program that ultimately triggered a relapse. Shira also happens to be an ED therapist. I wrote about it here: 

A number of people refused to donate to Shira’s GoFundMe for outpatient care, telling me it was “unethical” and “harmful” that Shira was a therapist when she wasn’t “recovered.” But I gotta be honest… that’s BS.

And I want to break this down carefully, because there are so many issues with the suggestion that mentally ill folks can’t be mental health providers. Namely, (1) ableism, (2) the practical reality, and (3) the big picture.

Let's talk about this, then.

(1) Yes, it’s ableism. Discrimination is a thing here. For starters, you’re assuming that mentally ill folks are inherently less fit for a job, regardless of their actual job performance, skill, and competence.

You’re also technically saying that only neurotypical people can be clinicians at the end of the day, as relapses are a PART of recovery, not separate from. There’s no such thing as “recovered.”

You’re selecting *ONE* potentially mitigating factor — disability — and assuming they’re less capable than their colleagues of relying on the skills and expertise they gained in their training. Without evidence of that actually being the case.

Those skills include a separation of personal and professional. They include the ability to determine when someone is compromised and when to refer. And this is on top of the supervision most clinicians already have.

The job requires empathy, the application of therapeutic techniques in-session, the ability to highlight a client’s strengths, and to synthesize info re: a particular condition or coping tool in a way that the client can then apply to their own lives.

A relapse does not inherently mean that a clinician loses the ability to provide that to another person. You're assuming it does, but on what basis? Assumed guilt without any evidence of malpractice or wrongdoing — other than "well, they're mentally ill" — is discriminatory.

Meanwhile, as Shira’s story makes very clear, there are plenty of clinicians with NO lived experience who are doing immense harm in the field.

But they aren’t held to this level of scrutiny, and their competence is *assumed.* THAT is the problem.

And that brings me to (2) the practical reality. How would you enforce pulling mentally ill practitioners out of the field when you believe they’re compromised? In the real world, how does that work?

Bc as far as malpractice goes, there are systems in place more broadly to protect clients. But you're suggesting something more specific is needed.

Why are we assuming that mentally ill providers are a special kind of risk that requires targeted, explicit client protections?

I can promise you, mentally ill folks are not rushing off to work eagerly if they’re truly in crisis and unable to handle the job. They’re arguably MORE likely to understand the stakes, have their own care team that they're accountable to, and step away when it’s called for.

If we’re saying providers must reach a certain threshold of neurotypicality, how would this be measured? Do relationship counselors lose their practice if they get a divorce? Do grief counselors have to prove they’re no longer grieving before they can resume their work?

And here’s the alarming but very important thing: Even if there were some measure in place to ensure every practicing therapist doesn’t have an "active" mental illness… that’s not actually going to help anyone.

For one, is there a screening process? How often do we screen? And does that mean employers will have access to medical records and other health information of their employees?

And we do this only to mentally ill providers, or all providers? And how can we guarantee the ways in which that information will be used won't be discriminatory against the clinician and be misused? How does that not violate their own right to confidential care?

Y'all... I HAVE QUESTIONS. Have you thought this through? Because now we're not just inching down a slippery slope here... we've got a toboggan and we're fucking sledding down it.

Because as I see it, this just means that providers with mental illnesses won’t seek out help or treatment. They’ll hide their condition and deteriorate for fear that they’ll lose their job otherwise. Backing clinicians into a corner doesn’t help them OR their clients.

That doesn't protect clients from malpractice and harm… it just casts a broad net at a specific population that will likely pull helpful, empathetic, effective clinicians out of the field, who are likely better equipped to understand their client’s lived experiences.

That brings me to (3) the big picture. This kind of discrimination would go on to replicate an existing hierarchy, because what it means is that providers who have the PRIVILEGE of accessing treatment will be more represented in care fields than those who couldn’t.

It worsens an existing systemic problem... while trying to remedy a fictitious one. It doesn't make any sense.

So in the case of eating disorders, the same thin, white, cis professionals who dominate the field would continue to be at the helm. While culturally competent, marginalized clinicians would be unable to practice unless they miraculously secure treatment OR hide their condition.

I guess what I’m wondering is why folks are asking “should mentally ill people be therapists” INSTEAD OF “how can we improve access to treatment so that mentally ill folks can be well and thrive in the field”?

I’m wondering why the response to the fatphobia that Shira encountered in treatment is to spin off into a hypothetical ethics issue, rather than taking these abusive, fatphobic treatment centers to task.

I find it shady as hell that instead of identifying **systemic fatphobia** as the real, tangible trauma and a significant barrier in access and success in ED treatment, the response is to question mentally ill providers for... existing?

Which is all to say, why are we asking this question at all? We should be focusing on access to adequate mental health care, and sick leave/short term disability to ensure clinicians don’t have to choose between their jobs and their health.

So my reply to you, ultimately, is to hold up a mirror for a second. Why THIS specific question?

Because barring someone like Shira from practicing would not change the institutionalized fatphobia that prevented her from getting consistent, compassionate, and proper care in the last 20 years.

And barring mentally ill people from a profession they could arguably be so impactful in doesn’t address any of the systemic issues that make it impossible for mentally ill folks to thrive in ANY field.

This casts unwarranted judgment and doubt upon professionals without consideration of how effectively they are doing their jobs in reality. You’re building an ableist hypothetical from a preexisting judgment, which serves no one when applied to the real world and its problems.

And so I’d just ask to reserve judgment of ANY therapist for their mental health struggles — shaming them into silence or discouraging them from a profession they could very well work wonders in — to consider a different question altogether.

So here are my questions for you.

Why — WHY — did it take decades of trauma and retraumatization for a patient of size to get adequate care? Why is a GoFundMe the only feasible way to secure that care? Why are insurance providers refusing to cover?

And why are we giving neurotypical providers a free pass to harm their patients because we assume that neurotypicality guarantees a kind of occupational competence that mentally ill people (apparently) aren’t capable of?

We should always question how to best protect clients and patients. But I’ll tell you what… even on her worst day, Shira is a hell of a lot better as a clinician than anyone was at the fatphobic ED center where she was “treated.” Some of y'all seem unconcerned with that.

if we’re looking at who’s actively harming patients… stop looking for pretend monsters under the bed, when there are ACTUAL monsters running treatment centers right now, leaving their fat patients to die.

And THIS, right here, is exactly why I created the GoFundMe for Shira.

Because I believe that getting people like her proper treatment so they can return to the field and transform it IS the only real path forward.


So no, I'm not sorry for standing by Shira, and for advocating for ALL mentally ill folks to pursue this field. Because history tells us that it's neurotypical providers and institutions, NOT mentally ill people, who have done the most harm and continue to. That's just the truth.

You can follow @samdylanfinch.


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