Carrying the burden of depression as a nurse.
As I read Anna’s (not her real name) description of how much effort it took to drag herself into work, how much she felt like a burden to her family, and her fear of being “found out,” tears welled up.
“I know,” I said to myself.
I was analyzing an interview transcript for a qualitative study of psychiatric-mental health nurses (PMHNs) who have experienced mental illness. More specifically, my colleagues and I wanted to know how their illnesses impacted their work as nurses.
I have been a PMHN for over 40 years, with an even longer experience of a mental illness. I recognized many of the participants’ stories in my study as my own
, but none affected me the way hers did. An alarm bell inside my head went off. If I couldn’t create a clear boundary in my mind between Anna’s experiences and my own, I might be at risk of unduly influencing the study results.
Reflecting on shared experiences of depression.
I was grateful that a colleague was also analyzing these transcripts; to minimize the effects of my own potential bias, I took the opportunity to write down my thoughts and feelings in my reflexivity journal. This is a tool used by qualitative researchers to examine ways their perspective could affect the research process by introducing bias. In addition to having more than one person conduct data analysis, keeping a reflexivity journal lessens the chance of attributing one’s own thoughts and feelings to study participants.
Journaling took me down memory lane—a road, in part, of hardship and despair. I recognized Anna’s exhaustion, guilt, and shame related to depression. You may be able to get to work, but emotionally connecting with patients is almost impossible. After your shift ends, you have no energy to engage with your family, which leads to guilt. Mental illness is highly stigmatized and can result in a person’s internalization of that stigma. Putting up a front that everything is “fine” takes a tremendous toll on the body, mind, and spirit.
But for all the pain and suffering that Anna’s story illustrated, it didn’t end there. She fought back, got into treatment, and most importantly, used her experiences to help her patients. Her accounts of interactions with patients were what touched me the most.
Applying the lessons of personal experience to practice.
Photo by Volkan Olmez on Unsplash
Anna never disclosed to patients that she had a mental illness. She didn’t have to in order to convey her empathy and understanding of their suffering. She had the words to articulate their pain when they didn’t. She didn’t minimize their complaints about drug side effects because she had experienced them too. Anna offered hope to her patients that they could recover because she had recovered. In the mental health field, recovered doesn’t necessarily mean cured. Being in recovery means that one can still experience symptoms of a mental illness but live a productive, meaningful life.
Acceptance: humbling and empowering.
Unlike Anna, I didn’t have the insight or readiness to accept my illness until after I left clinical practice. Even though I was in treatment, I saw myself as superior to patients. It wasn’t until I began teaching undergraduate psychiatric nursing and got involved with the National Alliance on Mental Illness (NAMI) that I began my recovery journey. I self-disclosed to my students because I wanted to counteract the negative image the public casts on people with mental illnesses. I gave students the words to describe feeling like a burden or feeling hopeless, language they then used when their patients had a hard time expressing themselves. I also, with great humility, admitted my biases. Having academic degrees and work experience as a psychiatric nurse didn’t make me a better person than anyone else with a mental illness. “Those people” I once referred to became “us.”
When first writing this piece, I felt I had wasted the opportunity to use my lived experience to help patients when I was in clinical practice. Upon further reflection, however, I’ve come to believe that my experience may have made a difference after all.
I will be forever grateful to the nurses, including Anna, who shared their stories with us for our study. They not only touched the lives of their patients, they touched mine, too. As hard as it was to relive darkness from the past, it gave me a profound appreciation for the present. My data analysis is complete, and I have removed my researcher’s hat. The fact that my story could intertwine with their stories is no longer an issue. It is our story.
Susan Brammer, PhD, RN, CNE, FAAN, is a professor educator at the College of Nursing at the University of Cincinnati. She has been a psychiatric-mental health nurse for over 40 years. Her professional experience, volunteer work with the National Alliance on Mental Illness (NAMI) and American Psychiatric Nurses Association (APNA), and lived experience with mental illness, has led to a lifelong passion for advocacy and stigma reduction.
The article sub-titled “Carrying the Burden of Depression as a Nurse,” really resonated with me and prompted this reflective response. Forty-five years ago, as a young nurse working in a stressful NICU, I regularly experienced the classic signs of generalized anxiety disorder–cold palms, a pounding heart, heightened senses–yet, I unconsciously repressed my symptoms appearing calm, cool, and collected on the outside. You see, four decades ago, it was not unusual to have multiple infant deaths over a short period of time; yet, loss was rarely acknowledged among nursing staff. We had to keep going as tiny lives were in the balance; there was no choice. Moving forward in time some 20 years later, I received a major depression diagnosis just as I was finishing my PhD in nursing, which was focused on fathering premature infants. Depression hit me like a ton of bricks, seemingly appearing “out of the blue.” I should have seen it coming, but I didn’t. As I think back on my life and career, mental illness was a silent companion, smoldering, until reaching a tipping point. With the care of a good psychiatrist for medication management and an outstanding psychiatric nurse practitioner as my therapist, I made a full recovery. As I reflect on my career, I can clearly see that I was in a constant state of burnout–yet kept plodding forward–until I couldn’t. My therapist once told me that my diagnosis would be a gift in my life (it was), and that some of the strongest people she knew were those who sought treatment for mental illnesses. I say this not to pat myself on the back, but to urge all nurses to stop, reflect, and take action if they are experiencing burnout, anxiety, and/or depression. It makes perfect sense that nurses are particularly vulnerable to these mental illnesses as we are caregivers through and through, often putting our own needs aside. I implore nursing administrators to emotionally support nurses, first and foremost. Simply put, nurses can not provide expert caregiving to patients and families without emotional nurturance. Nurses and their patients deserve the very best of care. All of our lives are depending on it.