Shame, Privilege, and Undervaluing Mental Health Workers

A little over a year ago, I released a new course teaching clinicians how to conduct asylum immigration evaluations.

I was beyond proud of the resources I’d put together.  After several months of grinding away behind the keyboard, working with designers, recording and re-recording lessons, I couldn’t wait to share them with my community.

But after it was all done, my mind and body were telling me I needed some rest.  I shut the computer and stepped away from everything to enjoy some much-needed vacation time.

When I returned, I was excited to see what the response to the course had been.

“Did people find it useful?” “Are they sharing it with their colleagues?” “Is this making it easier to help more clients in need?

I couldn’t wait to find out.  So, the second I was back at work, the first thing I did was jump into the comments of the new course.

Here is the first comment I read:

This course should be free! Therapists are doing these evaluations pro bono… Very troubling that you are trying to profit from this horror.   
– P

My heart sank. Worse than that, it felt like someone had taken a vice to it and squeezed.  I shut the computer and took some time to think, cycling through feeling sad, mad, and every other variation of bad.

I couldn’t believe it.

The truth is, the vast majority of the comments on the course had been positive.  But we know that, as humans, we are more sensitive to threat, loss, and negative emotions than we are gains and positivity—a phenomenon known as the negativity bias (Kanouse & Hanson, 1972).

As such, I couldn’t stop thinking about this comment and how I would respond if given the chance.

Now, it’s a year later, and I think I’m finally ready.

A Response to ‘P’

Dear P,

I’m sure what you and I share is a deep concern for the communities we serve.  How we go about that may differ, but one thing is not okay nor productive, and that is the use of shame to bring about change.

Brené Brown (also a social worker) defines shame as “the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging, and connection” (Brown, 2013).

Shame does not work.  Shame is not a productive tool for change, let alone when it takes place behind the veil of anonymity.  To quote Brown: “Shame is not an effective social justice tool.   Period.   Just period.   Shame is a tool of oppression.  Shame is a tool of white supremacy.   Humiliation, belittling—those are tools of injustice” (Brown, 2020).

I’d never thought of shame in this way before engaging with Brown’s work, but I believe there is a truth in what she’s saying.   Further, it reveals an irony in your comment, P.

A wish to see just and humane outcomes for our clients lies at the root of our work as immigration evaluation therapists.  But shame itself is inherently dehumanizing.   “Shame kills empathy, and empathy is the foundation of love and justice” (Brown, 2020).

We all know how painful it is to hear shaming words, yet they are so often used as a tool to try and change others’ behavior.

If we’re determined to bring about change and committed not to hurt others, we can use empathy to turn off the instinct to shame others and as a reminder to choose kind words when we need to communicate (Kirk, 2011).

Further, I think you’d struggle to find an immigration evaluation therapist in this business who does not have a huge heart and is driven by a desire to help others.   So let’s practice what we preach and be kind to one another whenever we can.

Next, there is an assumption woven into your comment, P, that immigrants may be unable to pay the fees associated with psychosocial evaluations, which, frankly, I take issue with.

There is an enduring and false rhetoric in this country that immigrants are a burden on the economy, when, in reality, immigrants are huge contributors to the national income.

While there are many ways to quantify immigrants’ contributions to the national economy, overall, they have been shown to contribute more to the economy than the U.S.-born population.   For instance, despite being 13 percent of the population, immigrants constitute 16 percent of the labor force (Costa et al., 2014; Sherman et al., 2019).

To downplay or ignore this reality is another way to disempower immigrants in this country by discrediting immigrants’ financial contributions.   Further, immigrants in detention centers often have family members and loved ones who are willing and able to pay for immigration evaluation services.   So please think carefully about your assumptions, P.

Finally, I think the thing that concerned me most about your comment is that you have shamed and discredited the hard work of mental health clinicians.

Perhaps you have the privilege of working for free, P.  However, most of us do not.  We have spent four years in college, obtaining a Bachelor’s degree, followed by at least two years in graduate school.  We’ve completed 1,500 practicum hours before being supervised for another 3,000 to take a state licensing exam.

If time is money, we as LCSWs should be worth a fortune.  Instead, according to the Bureau of Labor Statistics (2019), the median annual salary for social workers in the U.S. is $50,470 per year.

As a profession, I think it’s fair to say that we’re not raking it in.

Despite this, I’ve observed a strong external pressure to devalue our work, which translates into an internal pressure to do the same.

When doctors, lawyers, and engineers earn a good income, people may be envious, but they never shame them into giving their services away for free.   The same should 100% apply to mental health workers, but it does not.

Or perhaps it’s the other way around.

Imposter syndrome or some common characteristic about those who self-select into this profession drive LCSWs to devalue their work, thereby allowing society to do the same.

Either way, there is no shame in working hard to help people and being paid for it.   The two are not mutually exclusive.

So, P, I hope that you yourself are not undervaluing your contributions or allowing anyone else to do the same.

I hope that you have not been shamed into earning less than what your contributions are worth.

Closing Thoughts…

Here’s some food for thought that I often tell my students.

If you had a loved one who was gravely ill and you were searching for a specialist to save their life, would you encourage them to choose the cheapest option?

Of course not.   So why should one’s approach to seeking mental health treatment be any different when the work we do has the power to fundamentally change a person’s quality of life?

References

Brown, B. (2013). Shame v. guilt.  

Brown, B. (Host). (2020). Brené on shame and accountability [Audio podcast episode]. In Unlocking Us.  

Costa, D., Cooper, D., & Shierholz, H. (2014). Facts about immigration and the US economy [Fact sheet]. Economic Policy Institute.  

Kanouse, D. E., & Hanson, L. R., Jr. (1987). Negativity in evaluations. In E. E.   Jones, D. E. Kanouse, H. H. Kelley, R. E. Nisbett, S. Valins, & B. Weiner (Eds.), Attribution: Perceiving the causes of behavior (p. 47–62). Lawrence Erlbaum Associates, Inc.

Kirk, M. (2011). Shame on you! Do you use shame to control others?

Sherman, A., Trisi, D., Stone, C., Gonazales, S., & Parrott, S. (2019).   Immigrants contribute greatly to US economy, despite administration’s “Public Charge” rule rationale. Center on Budget and Policy Priorities.  

U.S. Bureau of Labor Statistics (BLS). (2019). Social workers.