When Berrak revealed to acquaintances she hadn’t slept in days, they told her not to drink so much coffee. When she told her family she was depressed, they told her she should just be happy and shouldn’t medicate herself to get through life. When Berrak, a 36-year-old in the Pacific Northwest with diagnosed depression and bipolar II disorder, tried to request accommodations, like working from home, “I would be called out for it and have to over-explain myself,” she says. (I’m referring to her by her first name to protect her privacy.) “It was exhausting.” The disbelief and dismissal have made her feel “like I couldn’t trust my own brain,” she says.
Chronic doubt of this kind—being talked down to, brushed off, or otherwise invalidated—is familiar to many people with psychiatric conditions, and often a defining feature of vulnerable periods of crisis. The phenomenon took place on the national stage last week, when Britney Spears made a rare public statement about her court-ordered conservatorship, which is controlled by her father. Spears lost legal autonomy over her life and finances in 2008 after being committed several times to temporary psychiatric holds. At a court hearing last Wednesday, she described the extent of the arrangement, including being put on lithium against her will and receiving a course of treatment and therapy she characterized as abusive. She described being made to go to an office to see a therapist, even after asking to continue treatment in the privacy of her home to avoid paparazzi harassing her as she left tearful treatment sessions. “It’s embarrassing and demoralizing, what I’ve been through. And that’s the main reason I’ve never said it openly,” Spears said. “I honestly don’t think anyone would believe me.”
The particulars of Spears’ situation may be unique, but for many with mental illnesses, being cast as an unreliable and untrustworthy narrator of your own existence and unfit to make even small choices and mistakes is all too familiar. To understand how frequently psychiatric patients face routine doubt and dismissal, I searched for relevant research and studies in academic journals. I couldn’t find much—though it’s unsurprising that we’re not paying much attention to the phenomenon of not listening to people. But you don’t need a study to know it’s happening to countless people. I myself have been told I am too healthy and privileged to be mentally ill and that I shouldn’t rely on my pills and psychiatry for the rest of my life; as a result, I have always felt guilty while taking medication that helps me feel better—as though there was something wrong with what’s best for me. For this piece, I spoke to people who have experienced these situations, too, to learn more about what it has meant for their lives.
Kat Rendon learned from other people that it was not helpful to be vocal about her mental health crises.
Rendon, a 24-year-old living in Los Angeles, has received psychiatric care since the age of 15. While in graduate school in New York City, she experienced her first manic episode; she stayed awake for four days and found herself walking around Manhattan barefoot in a nightdress at 4 a.m. “I had people tell me, ‘You’re making this up, you’re being ridiculous,’ ” says Rendon, who has since been diagnosed with bipolar disorder. “It was such a difficult moment. I didn’t expect people to be like, ‘What do you mean?’ and doubting me.”
Rendon and several others told me this reaction, repeated across time and people, feeds into a hesitancy to tell people how they feel. Eventually, that resistance turns into a reluctance to reach out at all—even if (or, perhaps, especially if) things get bad. “I now have a lot of trouble opening up to people,” Rendon says. “It puts me in a lonely position.”
And that can be a very dangerous place for someone who needs psychiatric help. Sharing feelings is not only a feel-good, cathartic relief; it also allows us to compare our thoughts and thinking patterns with others’, which in turn helps us calibrate the relative gravity of our own mental and emotional state. Holding it all in means sacrificing external reference points at the precise moment where they could offer an anchor or refuge from internal turmoil, says James, a 34-year-old in Los Angeles who has struggled with depression and substance use disorder. (I’m only using his first name to protect his privacy.)
Growing up in a household where he was told he couldn’t feel depressed, James perfected the mental gymnastics of ignoring his debilitating symptoms while simultaneously suffering under their weight. “It’s intensely othering. You feel othered from yourself,” he says. “I thought in the same way a lot of mentally ill people do, that I’m broken, or flawed in this deep way. That shame is the kind of thing that can kill a person.” Donna Arkee, 31, of Oakland, California, who lives with obsessive-compulsive disorder and panic disorder, told me they feel similarly ostracized by the way people react to their illness. “Nobody takes me seriously. What is wrong with me that people think I’m a joke when I say, ‘I’m mentally ill and it’s killing me’?” Experiencing doubt in addition to symptoms has been incredibly painful, they note. “It made me feel like a freak. It made me feel like I deserved to be miserable.”
When the external doubt comes from a mental health professional, it can be particularly dehumanizing. During my reporting, I heard stories of psychiatrists speeding to a diagnosis within minutes of meeting someone, or of prescribing certain drugs despite patients’ protests. Arkee told me that while receiving exposure therapy at a trauma recovery center, a therapist pushed them further than they felt safe going right away—in this case, asking them to touch dirt. Exposure therapy involves edging patients out of their comfort zones bit by bit so that they eventually no longer feel anxious or scared of, say, a little grime and germs. But Arkee, who was convinced they would die if they touched dirt, tried to explain to the therapist that things were escalating too quickly. “I was just constantly telling her, ‘No, I’m not ready,’ and she wouldn’t listen to me,” Arkee says. “They started pushing me and what I was capable of doing way too fast and way too hard.”
It’s a tricky problem for the field of psychiatry: how to provide objective care while trusting a patient with their own subjective narrative—some of which the treatment itself is designed to free them from. Properly employed skepticism can certainly help medical professionals to understand what’s going on; this is especially true for patients who are experiencing delusions, psychosis, or hallucinations. But it can also erode patient-provider trust and lead someone to abandon treatment and never seek it out again. “There’s this tension. We’re in this position where we often approach patients with a sense of doubt,” says Tanmoy Das Lala, a medical student and Ph.D. candidate in New York City who recently completed a formative psychiatry rotation. “But if someone makes you feel like shit, you’re definitely not coming back, and very often you might not seek care in the future.”
For treatment to work, patients need to feel validated and have a say in how things go. At the time they entered the recovery center, Arkee was spending hours each day on rituals, decontaminating themselves constantly and dressing body parts that touched dirty or unsafe surfaces like wounds, with Neosporin and gauze. But they felt therapists approached the situation with fascination, not seriousness or compassion. “I felt like I was being told I wasn’t in real pain,” they explained. Arkee says they could not help but feel their identity (as a brown person who is often read as a woman) played a role in therapists dismissing their requests for medications to ease OCD and panic disorder symptoms. “I felt very dehumanized. It’s hard to be told so many ways you don’t matter.”
The flip side of this is that when professionals listen closely, offer a diagnosis, and suggest treatment, it can be transformative, Berrak says. For her, getting a diagnosis and a plan that addressed her needs fulfilled a desperate need to be seen, recognized, and understood. “It made me feel like it wasn’t just something I had to live with,” she says.
Last week, Britney Spears pleaded to be allowed down the path toward restored health—to be heard, not ignored; valued, not demeaned; given agency, not leached of control. “I apologize for pretending like I’ve been ok the past two years,” she wrote on Instagram after the hearing. “I did it because of my pride and I was embarrassed to share what happened to me.” She has our attention. Many more deserve it, too.
To understand more about how the #FreeBritney movement reflects the problems with guardianship and conservatorship, listen to this episode of What Next.