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In the final episode of our Coping With… series, I’m joined by Clinical Psychologist Dr Catherine O’Leary, author of Coping with Psoriasis, to explore the psychological impact of living with a visible chronic condition, and the relationship between her personal experiences and professional life.
Catherine shares her experiences of living with psoriasis since childhood, and how she gradually found the confidence to speak openly about her condition and bring her lived experience into her professional work. We discuss the challenges of navigating professional identity, self-disclosure and vulnerability, particularly when working in a helping profession.
Our conversation explores the emotional and psychological impact of psoriasis, including experiences of shame, stigma and unwanted attention from others. Catherine shares practical strategies for managing difficult social situations, alongside the importance of emotional awareness, validation and self-compassion.
We also consider the relationship between stress, emotions and physical symptoms, and why it is so important that healthcare professionals recognise psoriasis as much more than a skin condition. Catherine reflects on the value of feeling seen and understood, and how clinicians can better support people living with psoriasis.
Finally, we talk about Catherine’s experience of writing Coping with Psoriasis, the responses she has received from readers, and the importance of sharing personal experiences to challenge stigma and offer hope to others.
Useful links
- Buy Coping with Psoriasis
- Coping with Psoriasis – Catherine’s website
- Dr Catherine O’Leary on Instagram – @drcatherineoleary
- Dr Catherine O’Leary on LinkedIn
- Coping with Psoriasis on Substack
- Psoriasis Association – Information and support for people affected by psoriasis
I’d love to connect with you so please come and say hi on LinkedIn or via my website.
The Coping With series is available via Sequoia Books and Routledge. ACP-UK members receive a discount on all ACP-UK titles – details are in the monthly members’ newsletter, The Buzz.
Do check out the ACP-UK and everything it has to offer.
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Transcript
Paula Redmond (00:04)
Hi, I’m Dr Paula Redmond, and you’re listening to the When Work Hurts podcast, which is brought to you by the Association of Clinical Psychologists, the representative professional body for clinical psychologists in the UK. In this series, I’ll be exploring the intersection of the personal and professional through conversation with clinical psychologists who have written about challenging life events and circumstances that they faced in the Coping With book series. We’ll be thinking about how these experiences affected them as professionals and how their professional roles and identities have intertwined with these challenges, as well as the wisdom, expertise and guidance they’ve shared with readers.
In the final episode in this Coping With series, I’m joined by clinical psychologist Catherine O’Leary, author of Coping With Psoriasis. Catherine draws on both her personal experience of living with psoriasis and her professional expertise to explore the psychological impact of this often misunderstood condition. We talk about managing unwanted attention and stigma, the challenges of navigating professional identity and self-disclosure, and the importance of emotional awareness, validation and self-compassion in living with a visible chronic condition. Our conversation opened with Catherine reflecting on what it took to feel ready to share her own experiences of psoriasis through the book.
Catherine O’Leary (01:36)
So I first got psoriasis when I was a child. So I would have been in primary school when I got the first few patches. And then it was when I was a teenager that really it took hold of me. I still have psoriasis. I still have treatment. Psoriasis is a chronic condition. So currently there’s no cure for it. And I’m also a clinical psychologist who specializes in working in medical settings. So the two parts of my life have run along quite closely, but it was only when the ACP series came out and the first few books came out that I thought about maybe this was something that I could do. It had been in the back of my mind that I could have some helpful advice and strategies for people, but I don’t think I was quite brave enough to put myself out there as someone with psoriasis until the series came out, which sort of coincided with my 50s. And at that point, I just felt a little braver about wanting to share not only my expertise as a clinical psychologist, but also my lived experience. And I think that was something that I was reluctant to do up until that point to actually talk about my own struggles and challenges with psoriasis. I’ve always been a very avoidant coper. So it was really having to confront that face on. So, that’s how I came to put forward a proposal as part of this series. So for me, it’s great it’s been part of a series because there have been other clinical psychologists grappling with the same sort of challenges, you know, about having to, you know, acknowledge and talk about your lived experience alongside your clinical expertise, which we’re not used to doing generally.
Paula Redmond (03:28)
Yeah, yeah. And tell us a bit about the book itself. What can readers expect from the book?
Catherine O’Leary (03:35)
I suppose I wanted the book to fulfill a few functions, primarily aimed at people with psoriasis. So currently in the UK, you might be lucky enough to be treated in a service that has a psychologist attached to it, and then you can access some psychology support. But for most of us, that doesn’t exist at all. And psoriasis is a condition that has a lot of psychological challenges that go alongside it, as I’m sure you can imagine. So there are many of us struggling with the impact emotionally and psychologically. And while we might be given tubes of cream and we might be given phototherapy or tablets, we don’t get the psychological support. So primarily, I wanted to share sort of psychological understanding with people so that people could sort of see what was going on for them psychologically because oftentimes we don’t take a step back, do we? You know, we don’t realize exactly how we’re struggling or why we’re struggling. So I wanted to give evidence and background into understanding the psychological challenges and then give people very practical strategies for managing those difficulties. I mean, essentially what I wanted was to write the book that I needed when I was younger that I need now that doesn’t exist. You know, it simply doesn’t exist. If you look at books on Amazon about psoriasis, it’s all about diets to cure psoriasis, how I cured psoriasis, the natural way to cure psoriasis. You know, I’ve bought plenty of those. They haven’t worked. So that was one side of it. So to give people an understanding of the psychological challenge, to sort of validate it, because you do get quite a lot from people, well it’s just a skin disease, you know, why are you getting so worked up? It’s just a skin disease and actually it’s so much more than that and it is really very challenging to live with. So I wanted to validate that a little bit.
Paula Redmond (05:40)
I think that is, you’ve done such a great job of that. For me, psoriasis is not something I’ve known much about, but you’ve done a really good job, you know, such a well-written book, both being really readable, but also you’ve really embedded research and evidence, you know, threaded that through in a really accessible way. So it’s been so informative for me to read your book and particularly the way you describe all the psychological impacts of living with psoriasis, just the layers of that. And it’s quite shocking that there isn’t loads of books like this written because it’s, from the way you’ve written it, it’s so obvious and so impactful what the psychological impacts of living with psoriasis might be.
Catherine O’Leary (06:38)
There’s lots of research, you know, there’s lots of publications and research about it, but there’s not much for people with psoriasis to explain, this is probably why you’re feeling like this. And it’s not because you can’t cope and you’re weak. It’s actually, there are very good reasons that you feel the way you feel. And so I did want to put all the research evidence in to show that actually this is very real. So I get a lot of messages from people who’ve read the book, and oftentimes that’s the thing that made the most difference was people felt seen for the first time, which… that felt really important to me. And actually, I think perhaps naively when I first came to it, it was more like, you know, what strategies can I teach people? But actually, I think the being seen is perhaps the most helpful part of the book for people with psoriasis. So that’s kind of the one side of it. And then the other side of it is I wanted something for people working in dermatology. Like, you know, they know how they work alongside these patients, they care for patients for many years. They know it’s a struggle, but oftentimes they don’t quite understand where that’s coming from or what to do with it. So sometimes those conversations don’t happen in a dermatology clinic because people are nervous to unearth things and then not know how to manage them or what to do with it. So I wanted to inform people working in dermatology, but also give them some sort of advice and information that they could use to support the patients that they’re looking after. So, and also for family members. So people have contacted me and said, you know, I’ve read your book, you know, I can’t believe how helpful it’s been and I’m asking my family to read it too. Or I’m taking it into work because they don’t quite understand why I’m struggling right now. So it’s both sides. I would hope that if you were a dermatology nurse or a clinician working in dermatology that this would, you’d feel more confident in being able to say to people how are you coping emotionally and knowing what to do with what you got back.
Paula Redmond (08:56)
Yes, yes. And that you have got some really useful sort of practical ways of applying that in the book for, for clinicians as well as.
Catherine O’Leary (09:06)
Yeah, and I think that the books in the series are all like that you know to be very informative and very practical and helpful as well you know.
Paula Redmond (09:16)
Yeah. So tell us a bit, Catherine, about your experience of living with psoriasis and how that’s impacted you. And I guess for this podcast, particularly curious about how that’s impacted you as a psychologist and in terms of your professional identity and your role.
Catherine O’Leary (09:35)
So when I was a teenager and I first developed it, you know, it was horrifying. Forgive me if I cry, because it still feels quite hard to think about. I think it’s very much tied up in the psychology of appearance, isn’t it? And how what we look like is so important. And with psoriasis, you can’t control that. And you know that people judge you because of it. So you very much… well, personally, and I know this goes the same for most of us, we learn to try and hide it. So we’ll wear clothes that cover our skin and we won’t wear dark clothes because we get flakes of skin everywhere and we’re careful about what we do and where we go. So, you know, some people with psoriasis are absolutely fine and they will go to a swimming pool, but for lots of us, we’ve kind of learned that people react to us. You know, if it’s flaring up on your legs, you don’t want to be in a swimming pool with people looking at you. So it really does very much limit what you do or what you don’t do. And hiding becomes a strategy that can be very effective. So lots of people in my life were surprised when I wrote the book because they didn’t know I had psoriasis, which to me is quite surprising because I often have very extensive psoriasis. So obviously I am the master of disguise. And sometimes that’s fantastic. So the changing faces offer a service where they teach you to use camouflage makeup, which is fantastic. I mean, not so brilliant for psoriasis because the skin is scaly too and it reproduces very quickly. So makeup isn’t always as effective. But what this means is you can effectively get on with life in a… and hiding it. You’ll be never really dealing with the emotions and you’re avoiding a lot of things that you would like to do. And I think that’s probably the way I’ve lived my life up until I would say recently, and the book’s come out, because now I’ve got much braver at letting people see it. And I think the trouble with developing something like this as a teenager is that teenagers are unkind and they do tease. But once you move out of the school environment, you know, people are perhaps more compassionate and less cruel, but you never learn that because you’re still, in your head, you’re that teenager who, you know, if everybody sees you, they’re going to be horrified. So don’t let them see you.
Paula Redmond (12:20)
And it also, I guess that that age is when we’re so self-conscious as well.
Catherine O’Leary (12:26)
Oh, it comes at the worst time, doesn’t it? And you just want to fit in and look like everyone else, don’t you? And the other thing that’s so hard about psoriasis is that it’s very difficult to control or predict. So you don’t know if it’s going to get worse or get better. You don’t know what you should be doing. You try everything. Everyone says, have you done this? Have you tried this diet? Have you used this cream? So I think that’s an extra burden, constantly looking for something to clear it up. You know, it’s hard work. It’s hard work. Now I would say as a psychologist, it’s affected me. It’s affected me practically. So I think anyone living with a chronic illness who is a clinical psychologist will know that they are managing two jobs essentially. You’re managing your job as a psychologist and you’re managing your illness, your appointments, your treatments. So I’ve definitely had that. And I think I have always, because I was so good at hiding it, you know, times I struggled, I would sort of double down and work extra hard. So for example, if I was having phototherapy treatment, that would be in a hospital outpatient department three times a week. So you’ve got to get there. You’ve got to park, you know, I’ve got children and I’m working full time, that’s exhausting, isn’t it? Practically, that’s really hard. And there may be days when I’m feeling, you know, when it’s flaring, you feel fatigue, you feel pain. And because I hide, I just say to everyone, I’m fine, and I carry on with my day. So I think practically, it’s had sort of big implications. And there have been times when I haven’t been able to hide it at all. So when I was a trainee psychologist, I trained at the Institute of Psychiatry, and I remember being in the canteen, it was lunchtime and a senior psychologist came over to me. I think I was by the water fountain getting a drink and said to me, I know what you’ve been doing this weekend! And I was like, do you? Very naively like, I can see, I can see you’ve had a good weekend. And I was like, what do you mean? And he pointed to my neck and I had a big plaque of psoriasis on my neck. And he was implying that I had a love bite on my neck. And it’s just those little, so, you know, obviously I was like, I have psoriasis. He was absolutely mortified as you can imagine. So now I’m dealing with that person being mortified. And I’m also thinking, does everybody think I’m blatantly going round the Maudsley with a love bite on my neck? It’s things like that. They’re very little and you know, we’re laughing about it now, but at the time that’s like, how, how do I, what do I do? Do I wear polo neck jumpers?
Paula Redmond (15:27)
Especially as a trainee, where you, where you, you know, you are also already feeling under scrutiny and you know, finding your feet with everything.
Catherine O’Leary (15:40)
So things like that, there are practical things that come with living with a chronic illness and one that affects your appearance. But the flip side of it is, I think it has made me a better psychologist. So up until I wrote the book, I wouldn’t use self-disclosure as part of my practice, but I think the empathy and the insight that I had because I specialized in working in medical settings has been very helpful throughout my career. That’s not to assume that everyone’s experience is the same as mine, but I think it helps me be curious and perhaps think outside the box a little bit about what people might be going through or what they might be dealing with. And I think I don’t assume. So for a lot of conditions, they’re invisible, and people look well and they come in glowing, but I would never assume that’s how they were feeling. So a lot of people might think, like, you know, what are they worried about, they’re absolutely fine. But I know that’s not the case. And that even at times when perhaps a condition is calmer or well-managed, that people carry sort of the psychological impact and the consequences of that. So I think it’s helped me be empathic and also be very curious as well. It’s definitely influenced my direction of work, you know, throughout training, anything that I related to myself and my psoriasis really piqued my interest, which is why I’ve ended up working in medical settings, because I just find it so fascinating, that link between physical health and psychological health.
Paula Redmond (17:35)
Yes, I was wondering about that, whether that your own experience had shaped your choices to work in healthcare as a…
Catherine O’Leary (17:46)
Yeah, most definitely, most definitely. You know, they’re the things that I want to read and I’m very interested in. I’ve never worked in dermatology, but I think, you know, a lot of the same principles apply across different conditions. And in fact, when I was a trainee, I did my large-scale research project at the time on psoriasis because I just thought, you know, this is my perfect opportunity to think about it and to look into it. So ever since, I’ve just been very, very interested in physical health and psychology.
Paula Redmond (18:22)
You’ve got a really interesting chapter about alexithymia. Am I pronouncing that right?
Catherine O’Leary (18:28)
Alexithymia. So it’s really interesting but for some reason there are a lot of researchers in psoriasis who have looked at psoriasis and alexithymia. So alexithymia in simple terms is like an emotional blindness. So it’s not being aware of your emotional state, what’s going on for you emotionally and perhaps not being aware of other people’s emotional states. I’m not sure why there’s so much research in psoriasis and alexithymia, because I think it’s probably common to a lot of people who experience a chronic health condition that is uncontrollable. And my take on it is it’s almost a coping, a way of coping, so that, you know, if I can’t do anything about it, I’m just going to say I’m fine and not think about it. I’m not, I’m going to sort of almost turn a switch off and just numb it all down. And you know, this is not because I’ve got something that I’ve had for a month, this is because I’ve had something for 40 years and you know, it’s painful. So this is what I’ve got to do to survive, is switch it off. So it’s a kind of coping strategy. So I think there are studies in other conditions and you do find similar rates and there is a high correlation with depression. So it’s you know, is possibly linked to that as well, that sort of flattening of emotions. But in psoriasis, there’s a lot of research into alexithymia. And part of that is so fascinating because, you know, if so many of us have switched off our emotions in order to cope, when we go to our dermatology appointments and they say, how are you, we’ll all say we’re fine. No, I’m absolutely fine. I’m doing really well. You know, which on a surface level is true, but when you start to unpick, there is emotion under it. It kind of extends. So people are alexithymic. They may not even be aware of their own physical symptoms, so that the pain that they’re in. So I see it in the patients that I work with, for sure, who’ve had real struggles and trauma, and they have just learned to switch off the emotions. The downside is, numbing yourself on one level helps you, but everything gets a bit numbed. So even the joy and the happiness and everything. I’m not reflecting on my internal world. I don’t know what’s going on. I don’t know if I’m happy, I don’t know if I’m enjoying this. That’s one downside. The other downside is I’m not telling people. So, okay, yeah, I’m not worrying them, I’m not giving them a burden that they won’t know what to do with, but I’m not getting the support that I need, you know, nobody is understanding that this is hard for me. And I, I’m not sure I was so, so, you know, if you filled out a questionnaire for alexithymia, there’d be questions on imagination and dreams and being able to tell, you know, the emotions of a character in a movie. I’m not sure that was ever the case for me. And I’m not sure how useful that would be as a clinical psychologist, but I certainly did do the, I’m absolutely fine. And if we don’t talk about these difficult emotions, I can keep going, you know, and you know, a level you do get by, but I think long-term it’s not an especially helpful strategy. But the good news is that as people get better, so if somebody was to treat my skin and I said, right, I’ve got a cure for you and it’s all going to go, then what you would find is the alexithymia kind of naturally dissipates and people then perhaps start being bit braver with noticing and acknowledging their emotions.
Paula Redmond (22:16)
Yes, that’s what I was going to say, because I thought that was a really fascinating point about how, you know, it’s not a fixed kind of, you know, character personality factor that, as you say, you know, once, if your psoriasis symptoms improve, then the alexithymia changes as well. That feels really important. Because it makes sense if that’s a way of coping. And shut down and numb things even from yourself as much as to others.
Catherine O’Leary (22:50)
And certainly therapy can help people, you know, start to notice and connect more with their emotions and what they’re feeling, which I think can be really helpful as well. So, yeah, so they can shift. I mean, it’s not even from a psychological point of view that it’s not helpful, but even from a physical point of view. I think there’s evidence that people with respiratory diseases who have high levels of alexithymia perhaps won’t respond to something like an asthma attack because they’re not aware they’re having it. Or cardiac symptoms. I remember seeing someone in the cystic fibrosis clinic where I work and she’d come in saying she was, to a routine clinic appointment, saying she was absolutely fine and in fact had a collapsed lung. So it cannot have been absolutely fine, but she had done that to, you know, been through lots of trauma with her condition and had done that to the nth degree that, you know, just, I’m okay. I’m, you know, I’m on the flat. I’m fine. Let’s just switch it all off, shut it all down. But I think what’s really important is that dermatologists are aware of this. So when someone comes into clinic smiling, yeah, I’m fine, but they’re absolutely covered in psoriasis, then they’re probably not fine. They’ve probably got a bit of alexithymia and so you need to delve a bit more and ask more questions. You know, how is your psoriasis affecting you today? What is it stopping you doing? What would you like to be doing? You know, how are you finding your treatments? Not just, this patient is fine, we gave them another tube of steroids.
Paula Redmond (24:33)
The other thing that I was thinking about in reading your book was some of these links between, I guess, research around lifestyle factors and kind of ways of coping that may be correlated with psoriasis symptoms and the kind of difficulty with messaging around that. Because I think, I mean, on the one hand, as you said, like there aren’t easy answers and easy, you know, there’s no quick fixes. There’s no magic diet or magic lifestyle change. And you describe, which I thought was really painful, was this process of like finding something that works beautifully, like the bath salts that made such a difference. And then you buy 25 packets and it doesn’t work again. And just such a roller coaster.
Catherine O’Leary (25:32)
When I was doing my A-levels, so I must have been 17, and my mum and dad bought me a bag of Dead Sea salts and I put it in the bath and it miraculously disappeared, you know, it all flattened and we were like, thank goodness for that, you know, and my mum and dad, bless them, they ordered sacks of it straight from Israel. Yeah, and it never worked again. So then we had sacks of Dead Sea salts, which you can’t eat. But yeah, it’s very hard. I think there’s, you know, we all, most of us with psoriasis have tried different lifestyle changes to try and control our skin from, you know, very strict diets to exercise to different teas to Dead Sea salts. And I think that’s only natural because you’re trying to find a cure, but can end up feeling a little, you can take it on as sort of feeling self blame. You know, that actually there is something I can do and I’m not quite getting it right. You know, this is my fault. And I think oftentimes the messages in hospital are eat better, lose weight, stop smoking. You know, all those things are good for you. Of course they are good for you. But that’s not why you have psoriasis. You haven’t got psoriasis because you’re a little overweight. Not at all, not at all. But you kind of think, you know, that people might be looking at you thinking that, thinking, well, this person’s not getting it quite right. The one thing that people often talk about with psoriasis is stress makes it worse. So that stress triggers it or stress makes it flare up, which lots of people with psoriasis say, but again that can become sort of a something you beat yourself with, you know, if you’re stressed, this is my fault, why can’t I manage stress better, why am I, this is your fault, you’re stressed, you’re obviously a stressed person. People tell me that all the time, even now, if my skin looks sore, someone says, are you stressed? You know, wherever I am, whatever I’m doing, however stressed I am or not, people always say that to me. It’s a funny thing, you know, if you had any other condition, diabetes or… people don’t say to you, were you stressed? Is that why it’s bad right now?
Paula Redmond (27:59)
Yeah. And it’s that funny, kind of like, you know, mixing up correlation and causation as well. Like probably you might be stressed if your symptoms are really bad. That sense of, you know, I guess when symptoms are, you know, not flaring up, you probably are more able to focus on other aspects of your health and wellbeing. So you might be more able to eat better, exercise more, engage in life more. And when your symptoms are bad, those things are much harder to do. But that doesn’t mean that, as you say, not eating well or not having a good lifestyle is what’s causing psoriasis. There might be a relationship between those two. And I guess, in a condition where there is, as you describe, you know, such, the kind of presence of shame is so palpable for many people who have this condition that it’s so easy to make that leap to blaming yourself, those messages don’t help.
Catherine O’Leary (29:20)
No, no. That’s something that I would say I still struggle with a little bit because I’ve always had the messages that, you know, if you eat junk food, if you eat sugary food, that’s what’s causing your psoriasis. So, you know, if I’m on holiday, I perhaps won’t enjoy an ice cream like everyone else in my family does because I get the guilt associated with it and it’s possibly not connected at all in the slightest, but I still am like, you shouldn’t eat that ice cream. You shouldn’t drink that glass of wine. You know, you shouldn’t be doing that. And as a psychologist, I think what’s complicated as well is, when people say to me, you must be like, they see my psoriasis, you must be stressed. So my body is signaling to the world that I mean, I’m not feeling stressed, but it’s people think that it’s a signal that I’m stressed. And then they’re like, what kind of clinical psychologist must she be? You’re like, I’m very calm, I’m very calm, I’m meditating. Yeah, it’s a funny one, the stress. But lots of people with psoriasis do think that stress makes things worse. But like you say, you know, when we’re stressed, we don’t sleep as well. Sleep definitely affects my skin. If I miss sleep, for good reasons, it flares up. You know, we eat differently when we’re under stress. We perhaps don’t apply our treatments when we’re under stress, and the actual research evidence is very, very mixed. So whilst people report that they think the stress triggered their psoriasis, there haven’t been any prospective studies that have been able to follow people and show that a flaring psoriasis comes after a stressful incident. So no one’s ever been able to do that. So it’s very anecdotal. And in fact, I think in the past, if you asked people what caused their psoriasis, they would come up with multitudes of reasons which didn’t include stress until about, I think, the 1970s or 80s when it started being reported as a trigger and then suddenly everybody is saying it. So there is something about expectation as well and plus when your skin flares you feel stressed. Then it’s a bit of a chicken and egg, isn’t it? I’m not sure which came first. But for sure lots of people say, you know, they didn’t have psoriasis and then they had a trauma, you know, a car accident or something and then it just broke out everywhere. So there is something going on. And the evidence is that if you practice something like mindfulness meditation, whilst it doesn’t clear up your skin, if you are having a treatment like phototherapy, if you’re doing meditation at the same time, it clears up faster. So it’s complicated, isn’t it? But I think the important thing is for people to kind of understand the complexity, to understand that there are multiple triggers that could be different for everyone, so that people don’t blame themselves because a lot of these triggers may be entirely out of our control like a throat infection or air pollution or hormones. So then it’s not your fault. It’s not because you’re not looking after yourself that you’ve got this condition.
Paula Redmond (32:33)
And just thinking again about the work context, for you, one of the things that you also talk about in the book is kind of unwanted attention and you’ve described that incident when you were a trainee and, you know, at the water cooler and there’s another example you talk about in the book, I think, when you were on an inpatient ward round. But you also have a really useful strategy for managing that. I wonder if you could describe that?
Catherine O’Leary (33:06)
Yeah, so if you live with a visible difference, people do comment, ask questions. Sometimes it’s unkind, a lot of the time it’s not. It’s just people are curious or it’s thoughtless. So you do get asked a lot. And, you know, when I was younger, I would respond, you know, with almost a panic now that attention is on me and on my skin and you know what, and I would, you know, like the thing with the psoriasis on my neck, you know, it sends me into a tailspin or even when I was younger, you know, on the beach and people asking if I’ve been burnt, what’s wrong with me? So I’ve always tried to avoid showing it and avoid attention as best I can, although that’s not always possible. So some years ago, I worked in a cleft lip and palate service in Guy’s Hospital and the young people that we saw then, we used a strategy that came from changing faces, which was to manage unwanted attention so that you didn’t end up feeling stressed or anxious or upset. And so I use that myself now. So it’s simple. So, you know, somebody asked you a question or comments on it, and the bit you mentioned in my book is when I was on the wards and the consultant yelled out from across a ward round, what’s wrong with your legs, Catherine? You know, what’s been biting you or something like that. So I just give an explanation; it’s psoriasis, which he knew I had psoriasis already. So he’s like, yeah, yeah, yeah. It’s psoriasis. And then the next thing is to a bit of reassurance, you know, like, you know, I need to get out in the sun and then I’ll be feeling better or, you know, I haven’t got a dermatology appointment for a while, but I’m being looked after, or something like that. But the real clever thing that I’ve learned and that I use all the time is distraction, so then change the subject entirely. So instead of then thinking you’ve got to have a whole conversation about your skin and yes, it does look bad today and yes, this is what you’re doing and da, da, da, da, da, change the subject entirely. Like, are you going to the meeting later on today? You know, how much longer is the ward round going to take? Am I able to use this room next? That’s in a work environment, you know, in a social environment it might be, did you see The Traitors last night? You know, have you seen anything good on Netflix? And people will let you take them away from the topic of your skin and the attention has gone away from your skin and you’ve dealt with it. So I find, I don’t always use that strategy, but I think having it in sort of my toolbox of things to do means that I am quite happy now to go out and about with my skin showing in a t-shirt and shorts. And I know that if somebody were to say, have you burnt yourself, I can be just like, no, it’s psoriasis, yes, I’m having treatment, you know, is there somewhere good to eat around here? And I’ve just ended it like that. I’ve dealt with it. But I do think it’s important to say that sometimes, you know, if somebody says, what’s that? And you want to give them a good long lesson on what psoriasis is, go for it. You know, they’ve asked, haven’t they? Tell them everything. And if somebody’s been rude, that’s never okay, you know. And, you know, people have different ways of dealing with unkind comments, but that is never okay and I guess it’s not down to you to make that situation better. But I think feeling, but most of the time the comments are not meant to be unkind, they’re just thoughtless and I probably do it myself to other people, you know with things I’m not familiar with, it’s part of being human isn’t it? So you know, I just manage the situation and I don’t think too deeply or too much about it after that.
Paula Redmond (36:58)
Yeah, I thought that was a really helpful example of a strategy. And you also talked in the book about practicing it or having a bit of yeah, a practice, a rehearse. Because I think I can imagine that would be just really supportive if that’s something you’re worried about, you know, maybe going into a new workplace or like you’re a trainee and after every six months, yeah, you know, at a new placement and just an added layer of kind of emotional cognitive labor in going into new contexts.
Catherine O’Leary (37:37)
Yeah, and the more rehearsed you are, the easier it becomes, the less distressed you feel. And then you’ve just literally dealt with it and it’s, everyone’s moved on, you know, and it’s fine. It’s absolutely fine.
Paula Redmond (37:49)
And I also wanted to ask you about your experience of being a patient. So you have worked as a health professional, but also in health care settings and hospitals. So very familiar with both sides, I guess, of that. And I wondered what it has been like for you to, what your relationship is like with that patient role when you also hold a professional identity?
Catherine O’Leary (38:17)
It’s interesting, isn’t it, being on both sides, as I suspect many of us clinical psychologists are, and the different roles we play. So my experience of being a patient, I think because I’m a clinical psychologist who works in medical settings doesn’t mean that, you know, I’m immune to all the challenges that come with being a patient. Of course, it doesn’t. So you know, I experienced the same sort of frustrations and upset. I remember when I was writing my book, because I was in the process of writing my book and I had a difficult consultation and, you know, I’d cried and I think I’d cried all the way home. And then we had a meeting that evening of all the authors writing the book. And I remember saying to them, I feel really fraudulent because I’m writing a book called Coping with Psoriasis, and it was very evident today that I am not coping with psoriasis. And, you know, I was in the moment and I was in distress, but I think that’s the point, isn’t it? Is that, you know, it doesn’t make us immune from the challenges. We still get the distress. We still get the frustration. Perhaps how we respond is different because of our psychological strategies and if anything that makes you in a better place to sort of be supporting people to cope.
Paula Redmond (39:46)
Yeah, I was just thinking that also that kind of being with your distress and in your distress does not mean you’re not coping. Like that is coping, maybe something to feel that, to allow space for, for the, you know, the frustration and the disappointment or the anger or the fear or whatever.
Catherine O’Leary (40:05)
Because that’s part of being human, isn’t it? And we’re all human. So, yes, so, you know, I have the same challenges being a patient as probably everyone else does. I cry, I get myself worked up before consultations. You know, what are they going to say? What are they going to do? What are they going to make me take next? What are they going to take off me? You know, how do I defend myself? How do I, you know, before every consultation, you have those kinds of conversations with yourself. I think as a clinical psychologist, it’s helped me because, you know, oftentimes working in medical settings we will get referred someone because they cried throughout their clinical appointments. And, you know, I understand that actually that’s quite normal. And it doesn’t mean actually they need psychology intervention, but perhaps a little normalizing and perhaps that’s more helping the staff to manage those emotions and that situation because it’s part of being human. It’s a part of being human. Having said that, I’ve done lots of work on sort of the importance of communication in consultation and shared care and being a patient leader. So I do try and use those sort of skills as well to kind of lead a consultation and you know, a lot of the time the dermatologists that I see are very good at doing that too and then it’s very helpful. So, but you know it’s always a challenge, it’s always and it’s lifelong for me you know I’m never not going to be a patient, it’s you know, part of me now and I will always need appointments and treatments and consultation and it’s not always going to be easy.
Paula Redmond (41:51)
Yeah. And I think that’s such an important message that even when you are someone who understands the system, has worked in the system, very well resourced, it’s still hard. And that’s not because you’re doing it wrong, and if you were different or better, it wouldn’t be so hard. It’s hard because it’s really hard. And how do you look after yourself?
Catherine O’Leary (42:14)
Yes. And I think that’s where the sort of the expertise, you know, how do I respond to that? What do I do? What do I need right now?
Paula Redmond (42:24)
And curious, because it sounds like the book was an opportunity to kind of really reflect on and explore your own experiences in a way that was maybe different from how you had related to them before. And then the sense of being very good at hiding. And then this is very public. And you’re talking about it, you know, to hundreds, you know, thousands of people getting feedback about your book, you know, that people have read it and what’s that all been like for you?
Catherine O’Leary (43:04)
Overall very positive actually. It was a scary process writing it and thinking, do I want to put that in there? You know at the beginning I was a little tearful and so in the book you know, obviously writing I can, you know I’m not crying so I can get it out easily, but do I want people to know that about me? Do I want to seem vulnerable? And I did grapple with that but overall I’m very very glad I did do it, because I think it is helpful to people to kind of understand my experience to help them validate their own experiences. So many people have contacted me and said, I sobbed reading your book because it was like reading my own story. So, you know, it’s nice to know we’re not alone and that there are more of us doing it. So overall it’s been really, really positive. It’s interesting because I think it was, you know, my husband has known me for many years, it was kind of, you know, and I wouldn’t have said I’m fine to him. I would have shared how I was struggling. So for him, it wasn’t a surprise. You know, he knew about the challenges, but for my mum and dad, I think it was. Yeah, because I think I’d always done that ‘I’m okay’. I think I probably still do it a little too. I don’t want to worry them, I don’t want to upset them. So I think it was probably harder for my poor parents to read about it because they probably took me from a lot of the time at very face value that I’m fine. And I don’t think they quite realized quite how hard it was and still is. So it’s a process, isn’t it? It’s part of it. If you’d asked me, you know, 10 years ago, would you ever do this and be talking about this on a podcast? I would have said absolutely not in a million years no. So I’m surprising myself.
Paula Redmond (45:12)
But also, I guess I’m just thinking what a great gift, as you said, to those people who’ve been able to see themselves in your story or that sense of being witnessed and validated.
Catherine O’Leary (45:27)
I hope so. From the feedback, it certainly has felt like that, which has been an absolute joy. And I have had messages from people all over the world saying, I’m in shorts for the first time in 20 years and I’m enjoying the sun. And people have sent me photographs from on holiday in a bikini. And that’s absolutely wonderful. So I almost feel like I’m on a mission now. You know, let’s all go out in shorts and t-shirts together at the same time. And then it won’t be surprising. People would just be used to seeing psoriasis and they’ll know what it is. But yeah, but it is nice to, and I think, you know, because it’s in a book, it’s everything, isn’t it? It’s understanding the challenges. It’s validating that experience and it’s the strategies. And I think I’m so pleased I’ve got it all there together so people can work their way through it and then hopefully come to a point where they feel, yeah, you know what? I am going to wear a bikini on the beach today. I’m going to do it.
Paula Redmond (46:34)
And you end with this beautiful letter to your 16 year old self, which yeah, I don’t think there’d be a dry eye at the end of that.
Catherine O’Leary (46:47)
Yeah, it’s really lovely. I wish I could have had that at 16. I think it would… but then, you know, we are who we are because of what we go through, aren’t we?
Paula Redmond (46:56)
Well, Catherine, is there anything else that I haven’t asked that you wanted to say or anything?
Catherine O’Leary (47:03)
I don’t think so. I can’t quite remember everything we talked about. We talked about such a lot. But no, it’s been lovely. Thank you for reading my book as well. It was lovely that you…
Paula Redmond (47:13)
Oh no, it was great. I really enjoyed it. Yeah, I learnt a lot. I’ve read all the books now. All the series, the whole series. I feel very clever!
Catherine O’Leary (47:21)
It’s been such a lovely series to be part of. They’re excellent, aren’t they? I found the other authors all so motivating and inspiring. It’s so enriched my life. It’s been wonderful.
Paula Redmond (47:40.75)
Thank you for listening. If you’ve enjoyed this episode, please support the podcast by sharing it with others, posting about it on social media, or leaving a rating or review. I’d love to connect with you, so do come find me on LinkedIn or at my website, and do check out ACP UK and everything it has to offer. All the links are in the show notes. Thanks again, and until next time, take good care.
