Saturday, 8 November 2014

Life - it's a risky business

The concept of risk is a curious thing. It has an unquenchable appetite. It will always maintain this edgy hunger – because it feeds on fear. It is endless and impossible to keep at bay or control and scratches at the back of the mind with the persistence of a buzzing fly. And yet, we throw ourselves against it, trying to measure it, counter-act it, guard against it, obliterate it. Do anything to make ourselves feel better about it.

Being alive is a risk. Waking up and getting out of bed is a risk. Getting into your car and onto the motorway is a risk. Eating is a risk. Interacting with other people is a risk, of getting hurt. Dating is a risk of rejection. Working is a risk of making a mistake. Loving is a risk of losing. Living is a risk of dying.

"It is only by risking our persons from one hour to another that we live at all."    William James

One of the fascinating dichotomies of working in mental health is how much time we spend working with anxiety. It is of course the worry of risk ramped up on the equivalent of amphetamine for your thoughts. It is a cauldron of every risk imaginable with the heat turned right up. We teach people to challenge their thoughts, to learn mindfulness to calm themselves and let their thoughts drift by, to set aside limited time to worry, to put some boundaries around thinking about risk.

But then, what do we as mental health professionals do with risk? We become obsessed with it. We assess the hell out of it. We record it on bits of paper. In triplicate. The “What if…?” thinking that we try to help our clients challenge and change is part of mental health culture, in fact, it is part of most workplace cultures. People get paid a lot of money to weigh up potential risks. Bean counters have very healthy pay checks and insurance companies have an endless source of income by tapping into our “What if…?” thinking.

So what am I saying? Just don’t bother with risk? Don’t try and keep people safe? Of course not. Of course we have a duty of care for the people we are trying to help and heal. But it shouldn't be about a piece of paper. What I am saying is that it is pretty hypocritical of organisations to be so risk aversive and risk paranoid. It is a paradox that mental health professionals have to work with extreme anxiety disorders when our workplaces have what could be diagnosed as institutional anxiety, organizational anxiety, societal anxiety. It does leave us with ethical dilemmas about balancing choice and risk, freedom and control. I think we spend a lot of time fooling ourselves. I just find it ironic that if organisations put their mindset, their thought-patterns, their decision-making processes under the same scrutiny that we encourage clients to do - the result would be interesting. I think it would show up some pretty unhelpful patterns.

Why is this important? Because to work with risk, to work with suicide, self-harm and other mental health issues, we need the right kind of support and back-up. Given the amount of burnout (that's a whole other blog post) I remain unconvinced that support is well thought-out. Supervision can become mechanistic, focusing on case presentation, techniques, outcome measures and procedures or questioning competence. What about the human beings at the heart of these interactions? How does it feel? What do we actually need from each other?

"Security is mostly a superstition. Life is either a daring adventure or nothing."    Helen Keller

I attended a lecture recently where the speaker said that around 50% of therapists will lose someone they are working with to suicide at some point in their careers. So I guess we have good reason to be antsy about risk. We have to find a way to work with it, to live with it, without it being the only focus. People need to talk about their thoughts of wanting to die and we need to find a way to listen.

Dr Murphy - signing off

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