"Alone in the room with my patient, our realities clash. My version of Ben as a mentally ill young man on the precipice of homelessness is no more defendable to him than his version of himself as the Messiah is to me. I'm trying to help Ben, right? I'm worried about him. I'm offering him a treatment that will make him see that he is not Jesus so that he is less erratic at home, so he can stay there, maybe get a job, maybe start dating, having friends."
"He is trying to tell me something. And I am dismissing it to push my agenda. He wants to help me too. It's important to him that he has something to offer me as well. I won't accept it. He doesn't want to stop believing he is Jesus. He is communicating that to me as clearly as he can. I'm insinuating his wants don't matter."
"I am telling him, with all the authority of my M.D., my degrees hanging on the wall above us, the office we sit in, the years I have on him, that his reality is invalid and mine is the only one of value here."
A psychiatrist reflects on an encounter with Ben, a young patient experiencing psychosis who believes he is Jesus. The provider attempts to coerce medication compliance by threatening homelessness, mirroring Ben's own ultimatum about salvation. The clinician recognizes this moment as a fundamental failure to listen. Ben is communicating his reality clearly, but the provider dismisses it to advance a treatment agenda. The provider's authority, credentials, and institutional power create an imbalance where the patient's perspective is invalidated. This encounter reveals how providers' anxiety and certainty prevent genuine engagement with patients' experiences, replacing curiosity with coercion and dismissing what patients are trying to communicate.
#psychosis-and-communication #psychiatric-coercion #provider-patient-relationships #clinical-listening #mental-health-ethics
Read at Psychology Today
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