Shame is a burden for many people who struggle with mental illness, but for leaders it can be especially intense, says Dr. Michael Groat, director of the Professionals in Crisis (PIC) program at The Menninger Clinic in Houston, Texas. Doctors, lawyers, entrepreneurs, and other high achievers, by definition, are driven, ambitious, and accomplished. They have high expectations of themselves and others have high expectations for them.
“A lot of our folks are used to being successful in various endeavors and having a sense of mastery. When they come up against something that overwhelms their ordinary capacities to cope, we often see the sense of failure...They describe worries about the stigma, and I think stigma is a code word oftentimes linked to shame, because of worry about the way status or reputation is going to be marred or tarnished because of the experience of mental illness,” said Groat.
Leaders, especially prominent leaders, are so demanding of themselves that they don’t allow for illness and psychiatric illness in particular, added Menninger Clinic senior staff psychologist Jon G. Allen. “They’re very resilient people, but we all have limits in how much we can be self-reliant and manage on our own. They hit those limits and then they are out of luck in a way, because they’re so used to managing on their own that they’re deficient in being able to rely on other people.”
Many leaders entering PIC are dealing with social isolation, said Groat. “Those are the people I worry most about. I worry when someone says they’re suicidal, but I worry most about the person who is alone in their despair,” he said.
PIC is unique, both men said, in that it allows professionals adequate time to immerse themselves in a therapeutic community. Residents receive individual therapy, medication management, and group therapy during their six-to-eight week stay.
In group meetings people are taught “shame resilience,” Groat said. They learn that shame is an experience common to all human beings and are taught how to move out of it and into a state of belonging. “As we’re vulnerable and we’re received by other people with empathy and compassion, that is the route whereby we move out of shame, because being received with empathy, being understood, and being cared about helps us become reconnected,” he said.
Some professionals must overcome family or community cultures that hold negative views of psychiatry and mental illness, Allen said. “In a sense, we’ve sort of won the battle once they’ve walked in the door. But we struggle with ambivalence and resistance. ..The patients have a huge role in … allowing themselves to be vulnerable...When one person moves along, that brings other people along with them,” he said.
Therapists also encourage people to repair and/or reconnect with their primary relationships at home. “We help them use relationships outside of work to give them the sense of security, confidence, and well-being that is essential for them to sustain that work,” said Allen. “When you can depend on other people emotionally, then you’re more able to be self-reliant.”
Reevaluating priorities while in treatment is common, as it would be for anyone facing a health crisis, Allen said. “Patients really need to rethink their careers. Of course, that is a major, wrenching process.”
Finding safe people with whom to share struggles at work can aid in recovery for those who do return to their former vocations, said Groat. “I don’t expect, nor is it reasonable, for the patients to be vulnerable to everyone. In terms of the workplace, we have frank discussions about identifying those individuals with whom they can be vulnerable,” he said. For example, a physician who went through the PIC program remembered an anesthesiologist who had described himself as “a friend of Bill.” This phrase can be code for members of Alcoholics Anonymous. The physician reached out to this AA member and was introduced to other coworkers who provided support.
“Those kinds of experiences of people finding allies, people finding safe havens, people finding a secure base to turn to does involve discernment. It does involve taking a risk and having it flop, then picking yourself back up and realizing that there are people who can benevolently and compassionately relate to you,” said Groat. “Recovery involves risk and I don’t see how any of us can grow without it...But, the more connected people are, the more likely it is that they’re going to have a solid recovery and the more likely it is that they’re going to remain healthy.”
While The Menninger Clinic is not a religious institution, it was founded by Presbyterians, and a chaplain is available for those who want spiritual guidance. Last year, Mark Roberts and other Foundations for Laity Renewal representatives visited the clinic to learn more about the PIC program. “The facility is beautiful, peaceful, and welcoming. The staff includes top professionals in several disciplines (psychiatry, chaplaincy, nursing, internal medicine, social work, psychology). Their teamwork approach maximizes the benefit for the people they serve,” said Roberts. “What impressed me most of all during my visit was the quality of the staff: highly-trained, experienced, deeply caring, collegial, and committed to an integrated approach to healing that includes psychological, relational, physical, and spiritual elements.”
Asked what he would say to a struggling professional who is ambivalent about investing six-to-eight weeks in the intensive PIC program, Groat said, “Ambivalence is very normal, and so I would expect that most people come here with ambivalence. The reason to consider The Menninger Clinic is that we can start with where you are, work with your ambivalence, and try to improve your life.”