Beyond binary thinking: Iatrogenic harm and good care – one person’s experience

Iatrogenic harm is a term that refers to harm, illness or other health damage that has been directly caused by medical treatment. This could be due to a system that has caused damage, or an individual.

One example of iatrogenic harm and its impact on mental health would be the after-effects of medical gaslighting, where a medical professional makes you question your experience of a medical difficulty. In practice, this could be a psychiatrist who tells you they don’t think your symptoms of depression are as bad as you are saying they are. It could also be a therapy that has invalidated your feelings. After experiencing this, you might find that you don’t trust medical professionals and this damages your ability to ask for help, or you may experience a worsening of your mental health difficulties.

How can we balance the reality of harm, no matter how inadvertent, with realising the on-the-ground stresses of mental health professionals?

I have lived through a lot of situations that have caused harm to me in this way. From being left in dangerous situations without supervision whilst staying on inpatient wards, to being dismissed by care coordinators, I have been left feeling traumatised by my treatment often.

However, I also know the amount of life-saving work services such as NHS mental health services do. I have been helped a great deal by the same systems and people who have harmed me and caused me trauma, which has at times created conflict in the way I view my treatment and myself.

I have also worked as a Lived Experience Practitioner in different roles, including as a Peer Support Worker on inpatient wards. This has given me a perspective that is hard to fully understand without experiencing it first-hand. Behind the closed doors of staff rooms, it is rare to see someone who isn’t putting their all into helping the people they work with. Mental health work can often be extremely stressful, and thousands of workers still get up, go to work, and do whatever it takes.

I do not say this to invalidate or dismiss medical negligence or iatrogenic harm. There is no excuse for poor treatment and being tired or overworked will never make it okay to cause harm and trauma to those you are supposed to be helping. Often, when it comes to iatrogenic trauma, we use different language and create a lot of excuses. Whilst all situations are different, I do not think it acceptable to use words that dismiss damage and absolve those who have done harm of any responsibility.

Moving beyond binary, black and white thinking

I now live in the aftermath of iatrogenic harm. I struggle to reach out for help and often burnout to the point of nearing relapse, fearing that I will be gaslighted or dismissed if I admit that I’m not well. I have nightmares about some of the situations I was subject to at my most vulnerable.

None of this will ever be acceptable. I can’t just forgive, but I can choose this without falling into black and white thinking, which is often my default.

Black and white thinking is a way of seeing things where there is no ‘grey area’. In this case, it’s hard not to think that all mental health services and their staff could be harmful. On the flipside, if you’ve only ever had good experiences, it can be hard to see this harm as a possibility.

Appreciation for the tireless work of professionals and appreciating iatrogenic harm

Perhaps a more realistic way of seeing this is that both things can be true. It is true that mental health professionals often work hard to ensure the best care for us, and that the systems they work under are often effective and beneficial. It is also true that harm often can be caused by these people and systems. Neither of these things should be seen as insignificant.

If you have experienced iatrogenic harm, I honour your feelings, whatever those may be. You deserved better treatment and still do.

If you are a mental health professional, thank you for your work.lin

Good care should be expected but should not go un-thanked. Bad care should not be expected; however, it is very much there, and it needs to be acknowledged. There is no point ignoring it – this will not remove the problem.