“But we’re not all like that!” We’ve all said it, haven’t we? Read or heard something that seems to criticise a group we belong to or feel part of and said, “But we’re not all like that!” I know I have. It’s instinctive. Especially so for those working in social care or the NHS, perhaps even more so for those working in mental health which seems to get criticism from every angle. There are many committed, hard-working, professional, compassionate staff who do the best they can in difficult circumstances, make a positive difference to people’s lives and do a really good job.
So when a dedicated GP or mental health occupational therapist hears a story on the news about terrible care in a service elsewhere, he might say, “But not all of us are like that!” A compassionate doctor or psychiatric nurse will read a story about a patient abused in another hospital and say, “We don’t all do that!” A social worker will see a story on a soap about a child being taken from its mother and say, “Not all social workers!” A psychiatrist or mental health healthcare assistant will read a patient describing their experience of poor care and tweet back, “But we’re not all like that!” It’s true: we’re not. But … And there is a but.
What happens when someone – such as a patient who’s had a brutal experience of mental health care or been badly let down by the NHS when she needed help – describes their experience and gets the response, “But we’re not all like that!”? What happens? The conversation stops being about the person who’s describing their own difficult experience and becomes … all about the person who’s interrupted. It becomes all about the interrupter talking about me, me, me.
Now that’s understandable … to an extent. We all have our own experiences and perspectives. We all have our own hot buttons or soft spots. Many working in the mental health field have, I’ve come to learn through twitter, their own personal experience of mental health problems – whether directly or through family members. It really isn’t them and us.
It’s always easiest to see our own perspective. But … there is a time and a place for raising it. When someone is describing their own experience of pain, abuse or neglect it may, I’d suggest, not be the time to butt in defensively and talk about yourself. Sometimes, a sense of perspective is needed. This is well illustrated, it seems to me, with this simple anecdote:
Me: Someone driving a blue Toyota just hit and killed my four year old child.
You: I drive a blue Toyota. Not everyone who drives a blue Toyota hits four year old children.
What does this do? I was talking about having been recently bereaved: you turn the conversation around to … you being a good driver. No doubt that’s true or, if not, you sincerely believe it to be the case, are a conscientious driver and are genuinely offended at any suggestion you might not be. Perhaps there have even recently been stories in the press about bad drivers. But … was I criticising drivers of blue Toyotas? No. Was I criticising drivers? No. Was I criticising you? No. I was talking about the painful personal experience of bereavement.
Or, as mental health researcher Dr Sarah Knowles tweeted:
“I broke my leg :(” “Okay, but not all legs are broken. Why do you generalise? For example my leg is intact.” “I … what?!”
Put like that, it should, I hope, be obvious why the response, “But we’re not like that!” is inappropriate. And how responding or butting in with, “But we’re not all like that!” derails the conversation and belittles the experience of the person describing it.
It’s not about you.
Why do I raise this now? Because the “But we’re not all like that!” argument was raised earlier this evening in a twitter conversation. The conversation did – as these sorts of things so often do on twitter – broaden out to include many other tweeps and move on to other debating gambits, such as victim blaming, “if you can’t stand the heat, stay out of the kitchen” and the “them and us” culture. Read on for some fascinating insights and well-made points.
As Charlotte Walker (twitter @BipolarBlogger) tweeted:
“If someone has a terrible experience, I am going to honour that experience. There is no point in saying to someone who’s waited 18 months for CBT, ‘Oh don’t be harsh, in other Trusts it’s better.’ No use at all.”
And as NHS doctor Elin Roddy (twitter: @elinlowri) tweeted:
“I always remember you saying – just because you don’t work in a bad service doesn’t mean they don’t exist … It stuck with me and stops me getting too defensive (I hope) when people criticise health care.”
Next time you’re tempted to butt in and say, “But we’re not all like that!”, take a breath, pause and think … Maybe it’s not the right time to interrupt and hijack the conversation. Maybe it’s time, instead, to listen. Maybe it’s not about you. And, next time someone tries to stop you in your tracks with a “But we’re not all like that!”, maybe send them a link to this blog!
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- My Storify stories:
- This evening’s twitter conversation
- A continuation of the conversation on twitter (But we’re not all like that – part 2)
- Some twitter comments on the blog piece (But we’re not all like that – part 3) – it’s funny how how much push back I got to a blog piece on being defensive!
- But we’re not all like that (again) – 17th October
- The Racism School website (which I found a hard but illuminating read), where I first read the “blue Toyota” anecdote – HT @stavvers
- The positive effects of social media (mainly twitter!) on my mental health – My Journey Down the Road Less Travelled blog – read more about her here for another insight into why, sometimes, it might be inappropriate to butt in and disagree when someone is describing a painful personal topic – Simply Positive (twitter – @positivesimply)
- Reflections on “But we’re not like that!” – twitter, criticism & PPI – by Dr Sarah Knowles (twitter @dr_know) (19th August) – An excellent example of the learning that can come through engagement on twitter
- Derailing for Dummies – A how-to guide for trivialising and dismissing someone else’s perspective and experience. “After reading this guide, you’ll be able to marginalise anyone!”
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Sectioned 
A common non-sequitur – arguing against A by saying that B occurs? No – just argue against A with evidence to support that argument about A!!
Exactly – deal with the topic in hand rather than changing the subject and making it all about you. Especially when someone is describing a painful personal experience of poor mental health care.
I agree with the point you’re making here and the example makes the point well.
However, sometimes when faced with a horribly traumatic story, especially involving mental health, people don’t really know where to look or what to say, so in the struggle to say *something* so as to be supportive or not be seen to be ignoring the speaker, people come out with random crap. That probably only accounts for about 10% of it though, if that.
Yes of course: none of us is perfect and we try to do our best.
I’m thinking, in this blog post, about those who deliberately butt into a conversation about painful personal experiences and change the topic so it’s all about them instead. And persist in their need to be heard, despite having railroaded someone else. But thanks for your comment.
Oh I read this conversation a bit differently, am I missing some context? I didn’t see anybody describing a bad experience with mental health services. More just a general statement about attacking stigma and challenging poor practice?
I don’t think an unreasonable response to that is to ask to be more specific. I don’t think the intent was to tar all services with the same brush, but I guess that was how it was read.
I would deffo say its not a great idea to turn it all round to be about you when someone is describing a difficult experience, but yeah like I say I feel like I’m missing something here
Thanks for your comment. Although yesterday’s twitter conversation prompted me to write this post, the latter isn’t about the former. The conversation yesterday was simply one illustration of how “But we’re not all like that!” argument can be used to try to stop people – especially those who are not in positions of power – speaking out about bad experiences. Hope that helps.
I can understand professionals in these circumstances either not knowing what to say but wanting to be positive or trying to Make the patient feel better, but surely it’s better to listen to what the patient has to say and then say (if you must) something like ‘that must have been very upsetting/traumatic (inset appropriate word) for you, but I will try my hardest to make sure that doesn’t happen to you while you are here/I’m treating you (again appropriate wording for situation)
Gives you something positive to say, but doesn’t detract from the bad experience being relayed to you, and keeps it about the other person.
Yes. Well said.
I suppose that mental health OTs or SWs or CPNs have a much stronger collective identity than blue toyota drivers. They feel they have a common mission. The retort of the blue toyota driver would only make some vague kind of sense if there was some kind of possibility than they were actually being accused of committing the crime.
Mental health workers who say ‘we’re not all like that’ care about their work and driving up the performance of teams and the care of people who need their help. I didn’t read that exchange as being about trying to dismiss the experience of Charlotte, but as about giving hope that the situation could be resolved.
The blue toyota driver only wants to absolve themselves. But the mental health worker is saying we can recognise things are not right and try to make it better.
Thank you for your comment – though you seem to have missed the point.
This blog is not about OTs, SWs or CPNs. It is not about blue Toyota drivers. It’s not about Charlotte. It is not about you.
It is about what happens when someone butts in with justifications. Case in point, it seems.
Yes I agree – should be listened to and not justified.
Good Article. In my experience, be it with the NHS, or at work, if somebody has a problem, or a criticism, it’s not about saying ‘but we’re not all like that’, and instead asking ‘how can I help?’, or ‘why do you think this / feel this way?’. It’s about my health. It’s about respecting me as a person. Not about you defending yourself.
Yes, well said.
I love this blog. It shows how we need to be willing to listen and put the persons expedience first. A useful reflection for us all.
Thanks for your comment. I’m glad you found the blog helpful.
*a social worker attached to the mental health team, once asked me – ‘Have you thought of divorce’ !
just after my wife ( who suffers from Schizo-effective disorder for the last 20 yrs. )
had gone through another Crisis period and we asked them for support.
There are idiots in every profession I guess! I’m presuming you didn’t take their suggestion 😉
… my wife and myself are together ; for life. we love each other.
i did make an official complaint about the social worker though – no action was taken ( am sure she is still out there ‘helping’ !
Still confused as to why my reply is grouped with the defensive comments in your Storify. It was the opposite of ‘yes but some of us are lovely’. It’s effectively ‘yes, sorry, sometimes we can be shit’. Sorry if you felt this was still ‘making it all about me’ but I also explained this is a response to what i’ve often found as people feeling like it (whatever it is) has been done deliberately. Unless of course it was done deliberately in which case I’d be finding a complaints form…
Hi Kath, I’ve posted 3 Storify stories with hundreds of tweets so identifying which one is yours when I don’t even know your twitter name or which story it’s in would be a tricky task … If you let me know who you are (your twitter name) and which of the 3 Storify stories your tweet appears in, then I’m happy to take your tweet out of the Storify story. Hope that helps 🙂
Okay I don’t really know how Storify works, if it’s just taken wholesale from Twitter fair enough.
Reblogged this on JVR's Musings on Management and commented:
I liked this for its simple admonition not to make any conversation about yourself, but to continue to listen. Getting defensive, and thereafter hijacking the conversation with defensive comments, meets Shakespeare’s test for “doth protesteth too much.” The irrationality of generalization will become apparent in due course. Just be patient.
Thanks for reblogging, for your thoughtful comment and the Shakespeare reference.
The play to which you allude seems apt in the context of a mental health blog, since Hamlet’s struggles have been interpreted as a study in psychosis and, perhaps, bipolar affective disorder.
On the other hand, I understand the words you quote (spoken by Hamlet’s mother, Queen Gertrude, in Act 3 scene 2) originally had a different meaning: in commenting on ‘the play within the play’, Gertrude is saying the character in question is being insincere or over-promising. However, as you say, nowadays the words, “The lady doth protest too much, methinks” are interpreted as a reference to defensiveness.
Thanks again for your comment.
You are most welcome. I enjoy your blog!!
Thanks for a clear and important point well made. As a GP I’ve very frequently defended my profession against attacks which occur depressingly often, just as you defend people with mental health problems. A typical story that unites us is a story in the media about an attack carried out by someone with a mental illnesses in which demands are made for more stringent incarceration of people with mental illnesses etc. Our united defense is usually, “but we (people with mental illnesses) are not all like that!”
The stories attacking professionals are often used for political ends – the narrative structure of many stories demanding change to the NHS begins with a personal tragedy which is used to illustrate a wider point, e.g. the story begins with a neglected relative and goes on to claim that there is a crisis of compassion in the NHS, that nurses are interested in themselves but not their patients, and their terms and conditions are far too generous etc. rather than examining the particular context/ circumstances of the case where this particular elderly person was neglected.
Your point still stands, but please be aware that those of us who are quick to say “but we’re not all like that!” may be objecting to the way personal stories are manipulated for political gain.
Finally, having said that, I do think that stories are incredibly important and can and should be used to change things for the better, and you and other bloggers great exemples.
Sent from my iPad
Thank you for taking the time to write your thoughtful comment. There’s a lot in what you say that I agree with. However, like Dr Cunningham, you seem to have missed the point I am trying to convey in this post.
There’s a lot to unpack in your response but, rather than addressing each point, I will leave you with this to reflect on. The blog post is not about defending people with mental health problems, the mere use of the word, “But …” nor of the phrase, “But we’re not all like that.” Instead, it is about the use of the phrase in the context described.
I would really recommend taking a look at this response to my post by mental health researcher Dr Sarah Knowles (whose work involves patient involvement in research studies – PPI):
She used it as an opportunity to reflect on her own practice and came up with these three personal learning points:
“So, I’ve made a mental tick-list now of things to remember next time this happens:
1. It’s not about me. If someone is using twitter to get something off their chest, to express their frustration or disappointment, this is not a klaxon saying “hey Sarah, someone is saying Something About PPI which is different to what you’d like – get in on that!” This is especially the case, I’ve realised, when actually it’s several people talking to each other in a conversation which I just happen to be able to see because I follow all of them. I wouldn’t appreciate someone butting in on my much-needed venting conversation with a friend in the pub, so don’t do it on Twitter.
2. One of the reasons I joined twitter and follow these people is to get a broader perspective, to hear views I wouldn’t normally hear. Not to try to change those views instantly or contradict them. Be careful what you wish for…
3. The people who’ve had these experiences are usually the ones who’ve been willing, and are still willing, to engage in public involvement, to work with researchers, to try to make the ideal a reality. They are exactly the kind of people that I am grateful for and that I need to learn from, not some enemy-of-PPI who is trying to undermine the approach. The best thing I can do is listen and learn, not leap in with a defence of PPI as bloody-wonderful-actually-thank-you-very-much.”
Thanks again for your comment.
I really appreciated this blog. It made me think quite hard why staff can be so upset to hear about poor experiences and how that leads some to appear to negate them by saying they/their colleagues aren’t like that. This isn’t acceptable but it is understandable; to hear that those who are meant to have provided therapeutic care have actually done damage (whether accidentally or on purpose) cuts good practitioners to their core.
Best practice in such circumstances is to put aside one’s own feelings and listen really attentively in order to validate how the person feels and, at the right time and not before, enquire whether they want to explore techniques that may help deal with the experience and place it in the past. Treating post traumatic stress is a very skilled aspect of advanced psychological practice; done badly, the patient can either be retraumatised and encouraged to ruminate extensively, or denied the opportunity to deal with the trauma and put it where it belongs.
I speak as a nurse with a degree in psychology who runs a mental health trust, by the way – I am NOT an advanced practitioner at all – but I am blessed to work with many who are!
Thank you again for making us all think. The discussion on Twitter about planning physical care and mental health care in a more integrated way grew out of our later discussion, and was also very interesting!
Lisa
Your comment is much appreciated. Thank you. I’m glad you had a useful conversation arising from it too – twitter rocks!
I think there are serious problems with mental healthcare systems that affect not just patients but caregivers When individuals encounter problems, they often blame the individual they encountered the problem with. Sometimes, yeah, there are individual caregivers or individual patients who are responsible for a particular issues. Still, you are right that prejudices for an entire group based on this are wrong. But I think the worst of it is that it takes the discussion away from looking at the bigger issue, the system and its mindset and approaches, insufficient funding, etc. When we identify a systemic problem and fix it, we bring about systemic change that affects the many. When we rely on prejudices and blame of individuals, we just go in circles and at most, change one individual issue.
Thanks for your comment. I’d say that, when someone is talking about a painful personal experience on twitter, especially when they’re feeling fragile, it’s not their responsibility to try to look at the bigger picture and fixing the system. There’s a time and a place for that – but it may not be then.
True. You are right. Listening without taking it personally is more compassionate and supportive and can lead to richer insights for those involved and ultimately all. I have seen and read about many painful incidences and even tragedies, and experienced my own to think the problem is a few ‘bad apples,’ I have also seen and read about problems and frustrations of caregivers, some of whom were pushed to the limit and began experiencing their own mental health problems caused by stress. My mind was in that when reading your post and it got in the way of fully grasping your point!. You are right that ‘we are not all like that’ can be dismissive.
I witnessed the Twitter exchange that led to this blog post. It certainly opened my eyes and made me stop. I work in a care home and with all the negative press out there, I do say, “but, we’re not all like that”. After this particular Twitter exchange I am practicing shutting up. It is better to actively listen, because it really isn’t about me.
Wow, thanks so much for your comment. I’m really pleased it’s had a positive impact on you 😀
I think this blog is brilliant – no one should trivialise or try to compare themselves with you. I as a mother have been compared to staff “I know how you feel – I am a mother myself” or “I have a very good relationship with my daughter” – even God has been brought into conversations and then you are blamed as a mother for the adverse behaviour when in fact such behaviour could be caused by the mind altering drugs that can lead to Akathisia and I have read and researched all about these. One of the things my daughter said was “why wont they listen, Mum” – well I have listened and spoken up for my daughter and this has not gone down well at all. I am critical because the care has not deal with a traumatic event and intensive trauma therapy has not beent given – instead mind altering drugs are given and then a patient gets ignored and I have seen patients standing outside the office crying out for attention and being ignored. A patient should not be ignored if they are experiencing terrible problems with a drug and then forced to take that for the rest of their lives. I have seen patients – the same ones returning time and time again to the wards so there is obviously a problem with the care. It is not just the care on the wards – it is care in the community that is failing and that is because some staff take the wrong attitude that “she will be more happy with h er own kind” – well I believe in integration as this can be educational and dispel any misconceptions that mental health patients are all violent criminals when in fact this is FAR from true but some are vulnerable and why should they be locked away forever because there is no facilities within the community and this needs more investment and some could benefit from therapeutic communities. I noticed how patient comforted patient on the wards when staff were in their office. So many of these patients have got a lot to offer and yet are excluded from society and treated worse than criminals. I as a mother have been treated like a criminal but many professionals are very defensive – no one likes criticism but they try to compare situations with themselves so I have come across – I have read the criticism and comments about me in the files but my strongest criticism is the way the team have chosen to gang up and bully. I would never compare my situation with anyone elses or state that “it does not seem so bad your situation” – I would never trivialise someone elses experience as I know exactly how this feels and have listened to how my daughter feels.
A very well written account. Balanced with judicious and fair reasoning. Valuable.
Reblogged this on Stuck on Social Work and commented:
Thanks for reposting this today! Great perspective about the importance of listening to the patient experience.
Reblogged this on summoning esther.
Well said! I suspect the
knee jerk defensive ‘but we’re not all like that…’ , may actually mean, ‘I’m scared I may be like that’ or ‘please don’t make me consider I may be like that’ …We do not defend against things that pose (ego) threats.
I get a lot ‘we’re not all that’ when I speak about racism too. It’s asking the distressed to change their narrative that it reduces the anxiety produced and, it’s oppressive. Stay with the pain and anxiety for a few minutes. That the compassionate thing to do. Those who recount will probably live such such pain day in and day out.
Reblogged this on Thabomophiring's Blog.
I think, what you’re describing is a distancing tactic.
No good person wants to be part of a system that can actively harm people. Their instinct is to shy away, then self validate by proclaiming “I’m different”. Ends up being a kind of Denial.
Patients and staff need to join together to fix mental health care. Staff can help by opening their eyes and talking to patients about their experience and opinions.