ON BEING NON-EMPLOYED

It's more than two and a half years now since I last worked. Although I was pretty numb and in shock after my diagnosis in November 2010 and couldn't really think straight, one thing I knew very clearly was that there was no way I could carry on working while I was having chemotherapy. Part of that was the unknownness of how I'd tolerate chemo, but it was also because I knew there was no way I could carry on offering psychological therapy in my state of mind. It might have been different if I'd been working in another field of psychology, but HIV has a lot of parallels with (my) cancer: a serious, incurable and potentially life-limiting condition; where the medication aiming to control it can have very unpleasant and toxic side-effects on major organs, and decimate the quality of life; the uncertainty about when it might develop into progressively worse stages; plus the fear - even if much less likely these days for HIV - of a horrible death as more and more of the the body ceases to function. 

I knew, without even having to think about it, that this was all far too close to the bone for me to be able to work meaningfully with clients. For the first few months after diagnosis I was almost completely disconnected from my emotions, and that was how I coped; but it would have impossible to do good therapy in that state. There was also a very real possibility that client work could have stirred up in me emotions I wasn't at that time able or ready to deal with; and if I'd become swamped with my own stuff I'd have been unable to help clients. There was a danger I might have found it hard to sympathise with problems which could seem trivial compared to cancer, but been simultaneously terrified of hearing about how much worse life could get. Without being able to offer the right balance of empathy and distance, it wouldn't have been ethical to try and continue doing therapeutic work. (Probably this was why I also had no desire at that stage to meet anyone else going through cancer, feeling that if they were better off than me - such as having "only" a treatable primary cancer - I'd feel impatient with them and more isolated; but if they were worse off than me - having symptoms or pain or widespread metastases - I'd be scared of what might be in store for me and resent having to try to be sympathetic when I actually didn't want to hear about their situation.)

Wanting to be neither one extreme.......

.....nor the other

So it felt clear that taking sick leave was the right decision, and I'm very grateful for the generous sick leave that was available. However, after a year I had to decide whether I wanted to come back to the job or not, as it was unfair on the department not to be able to recruit into my post. At that time I was spending 10 days out of every 6 weeks in Germany, plus although things were relatively stable I never felt (and still don't) that I could take it for granted, and I couldn't see any way I could commit to taking on clients for therapy (which can last from a few weeks to a few months, and sometimes longer). Looking back, there was probably also a fear that I'd be somehow tempting fate, and that if I were to make commitments for more than a few months ahead I might suddenly deteriorate and have to stop again. Stopping work after being diagnosed, I threw all my energies into winding up my responsibilities tidily, either finishing with or handing over my dozens of clients, writing up detailed discharge reports and so on, and although at the time it was a welcome focus and I took pride in making a good ending, with hindsight it was pretty traumatic to leave a job of six years with two weeks' notice - and perhaps I couldn't bear the thought of having to do that again.

In addition, although I'd absolutely adored my job for the first few years, I'd been feeling increasingly stuck, as there was no opportunity for career progression. I'd known all along that there wouldn't be, but I simply couldn't imagine another job offering the same satisfaction, and it was becoming more and more frustrating to want simultaneously to leave and to stay. So it seemed wrong to go back into a job where I was beginning to feel trapped - it would have felt like a backwards step. I could have arranged to do only non-therapy work, but therapy was the main bit of the job I found so rewarding and stimulating; plus doing a purely admin role would have been a huge demotion, and given that my main dissatisfaction with work was not having as much responsibility and opportunity to make my mark as I wanted, it would have been doubly demoralising.

So I decided to leave, and overall I've never doubted the rightness of that choice. I took retirement on the grounds of ill-health (which was granted remarkably promptly, given the diagnosis of metastatic cancer), and now work feels like a distant memory: a phase which was long ago and feels quite separate from my current day-to-day life. Once in a while I feel guilty that I should be doing something productive if I'm capable of it, even just voluntary work, but mostly I'm grateful that I don't have to encounter the additional stress of work-related commitments, and that I can keep my environment mainly under my own control. Besides, it feels like a full-time job doing all my various therapies, and I don't have much energy, and I can't think of any job that would fit around the unpredictability of my situation (I feel quite superstitious, and even if I'm feeling OK today, I can't count on it being the same tomorrow, let alone next month). And although sometimes I worry that I've become too focused on my health, too caught up in a full-time patient role, overall I don't in any way want to be working right now, and it's a relief not to be expected to.

Until, that is, my practising certificate recently came up for its two-yearly renewal. Two years ago I was on sick leave so I renewed it without a second thought, but this time round I can't: to be certified as a practising clinical psychologist you must be either employed or keeping up with the Continuing Professional Development (training, meetings, conferences etc) required. As the terms of my medical retirement are that I've been signed off as unfit to do my job or anything similar ever again, there's no way I can pretend to be eligible to stay on the register.

And, totally unexpectedly, that's knocked me for six. As I said, I don't at all want to be working right now, but I guess I'd had a nice little fantasy that maybe one day if I felt well enough and confident enough that I'd stay stable, I could perhaps do some consultancy work, or run some kind of training, or do a bit of freelancing. But unless you're registered, you can't practise as a clinical psychologist (and to re-register I'd have to get a medical certificate contradicting what the previous one said, stop my benefits and change my tax status, then do a substantial amount of CPD - which is tricky to access when you're not employed - to prove that my knowledge and skills were up to date). Realistically, I can't imagine that happening. I haven't ruled it out - I know that occasionally miracles do happen - but I can't see myself in a position to go back into employment as things stand at the moment.

So I'm facing, for the first time, the reality that I'll probably never work as a clinical psychologist again. And it feels utterly devastating. I worked so hard to get onto a training course, and to get my doctorate and qualify; but more than that, the decade I spent training and in my job was such an amazing time. It opened my eyes, it helped me articulate what I felt and believed, it enabled me to think critically and see things from a variety of perspectives, and it gave me the opportunity to do work which I found fascinating, ethical, challenging and exciting. In my job I found like-minded people, with similar social and political values, and who were committed to human rights, respect for clients, and empowering some of the most marginalised people in society. 

I appreciated it all the more because during my twenties I'd done work I found interesting and enjoyable (hypnotherapy, stress management, on-site massage treatments in companies, and odd bits of reception work at a complementary health centre), but never really had any sense of vocation or ambition. In clinical psychology I discovered a profession which I had passion for, which I was good at, and which I seemed ideally suited to; and it was incredibly stimulating and motivating. I'd never before found my niche in such a wonderful way, or done work which I really believed in and felt energised and inspired by. It gave me a sense of purpose and direction, along with a strong connection to colleagues and clients, and allowed me to be part of something bigger than myself. And although I was still on a low grade because of the structure of the team I was in, I'd reached a level of skill and expertise from where my career could have flourished.

When I stopped work, I was so focused on believing I was about to die that I didn't really deal with what it meant to lose all that. It was a relief to be out of the inflexibility of the daily routine and the rush-hour commute, but otherwise I didn't really think about it, and when I did, I still felt and thought like a clinical psychologist - even now I still read the journals and talk to my ex-colleagues about psychology issues. It's true that I've become increasingly aware of how marginalising it is not to work, and although my friends are pretty sensitive, for the majority of them work is a fundamental part of their sense of who they are and their reason for getting up in the morning. So I'm conscious of feeling "different" and out of synch with my peer group, who by and large expect to have choices about their career and to have many more years to develop professionally. But I avoided thinking about it in much detail, telling myself instead how lucky I am to have family and friends, and financial stability (which are of course incredibly valuable, and without which life would be profoundly more difficult, distressing and demoralising - but they're not the same as having a career you love). I therefore managed pretty well to ignore what it really meant to me, until I had to formally declare myself as out of the game, and discovered how painful it was.

So I procrastinated for weeks about filling in the form to be taken off the register; and signing and posting it felt unbearably final. I don't think I was capable of dealing with the loss of my professional life and identity until now, so maybe it's a good sign in a way that I'm gradually coming to terms with how irrevocably cancer has changed my life and prospects. But all the same, now that I'm truly confronting the reality of it, I'm gutted.