I am usually writing these columns from my perch as a psychiatrist, and a distinguished-ish one at that. However, I have been one with an illness. I’m a…patient. Today’s article is very much from that vantage point, to explain to other health professionals how those of us who are patients think. This is not restricted to psychiatric illness, but is more pronounced the more stigmatized the condition.

I’m going to use we here, but it’s the royal we. We are always on the lookout for bigots. We know you judge us. We know you don't take us seriously. So, especially when we first meet, if we tell you about our lived experience? It is not casual. It is a test. We need to know if we can trust you. And the second you demonstrate we can’t? We're never gonna take you seriously as a health professional. We're never gonna tell you the truth about our suffering, not when it matters the most. The relationship we have with you will be circumscribed. We will treat you the a way lion tamer treat lions. It will be transactional, at best.

We're on the lookout for any little thing. We've been doing this “ being an ill person” as long, or maybe much longer, than you've been a physician. Physician-Hood has only been part of your life. People have been looking at us like we're crazy or sick for maybe as long as we can remember. It’s as least as long as since we got sick. That side eye? That condescending smile? We are on the lookout. Always. We cannot avoid noticing. All of us have some degree of trauma and hyper vigilance about our interactions with people like you, because I guarantee you, they have not all been positive. We have been dismissed. We have been judged. Some of us have actually been behind a door we unable to open because it was locked. Every interaction with you, dear professionals? Dangerous.

There is no reason we should trust you, in advance. This is a test. It will be baked into every interaction.

When we ask you a question? We might already know the answer. Again, we're testing you. We want to know if you will take us seriously. Your predecessors might not have. Some of them, again, almost certainly, did not. It may have been on the worst day of our life.

It's not fair to you. And it's probably not fair to us. But we absolutely, positively, should not blindly trust you. Until, of course, you prove you can be trusted.

The next time somebody like me raises their hand, even at a conference, and discloses the fact that we have a disability? It's not a casual question. We are looking to see how you react, and everyone else in the room in my position is doing the same assessment.

You're less good at hiding your contempt than you think. We are bloodhounds for BS. Respectfully, get comfortable with patients, or expect us to lie you every time it might actually matter to get a valid answer for us both.

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit thefrontierpsychiatrists.substack.com/subscribe