From my experience and what I’ve heard, providers make assumptions too frequently which end up being false and getting in the way of proper treatment. What are some of these assumptions? I’ve listed 3, but there are certainly many more!
One: All patients with a condition LOOK a certain way.
Last summer, I walked into a clinical psychologist’s office, someone I had been referred to by a professor who thought I seemed “depressed” (yes, that is the depression, but thanks).
In the initial call, I had said that I had Bipolar 1 and would like to see a psychologist/therapist. When I came into his office, he conveyed his shock that I appeared… so normal? So put together? That was actually incredibly offensive to me.
What should I look like?
Should I appear like I haven’t showered in 3 weeks, coming in with mascara running down my face?
Should I burst into the door with a frenzied look, pressured speech, and delusional grandiosity?
Should I have had a panic attack as soon as I sat down?
I mean… an experienced therapist should know better, right?
I could have suicidal depression or manic symptoms without appearing that different from anyone else. Don’t downplay the severity of the situation just because it doesn’t match some Hollywood theatrical cliche extreme version of my illness.
Two: A suicide attempt wasn’t REALLY an attempt. It was attention-seeking behavior, a “call for help”, etc.
Look: if a patient says they attempted suicide, you should LISTEN.
This seems so obvious, like stupidly obvious… but, you’d be surprised. I know someone who had an attempt and went to the ER. Given that the injuries were not incredibly severe, the attempt was brushed off like it was no big deal.
Do people need to come in on the brink of death to be taken seriously?
ALL attempts or episodes of self-injury should be taken seriously. It is a slippery slope and next time could easily be “too late.” Don’t let it get there!
Three: Your patient APPEARS fine, therefore they ARE fine.
It would be nice if a provider could just do a simple physical exam to detect things like depression or suicidality, but that is not the case. It is not something that is always clearly detectable by just looking at someone. Therefore, if someone LOOKS fine, you should never ASSUME that they actually ARE fine. Some people have learned to hide symptoms incredibly well.
Why?
Some may be seeking something, like permission from the doctor to go back to school or work.
Some may be in denial of their illness.
Some may be attempting to avoid being diagnosed with a mental illness.
Some may be trying to appear fine so that their family, friends, or significant other do not worry so much.
I know that there are not nearly enough providers, and often there is not enough time to give each patient the time they deserve. However, know that making assumptions could lead to misdiagnoses, worsening of conditions, and the overlooking of active patient suicidality.
Remember: each patient’s story is different.
What are some assumptions you have dealt with from your experiences?
The Calculating Mind 
Great post. I had a suicide attempt many years ago. The psychologist assessing me said “Well you don’t seem suicidal” And sent me home where I could have another go. I’ve had good treatment from services and I’ve had some terrible. I agree with highlighting both. (John)
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Unfortunately, some providers do not take cases (even suicidal ones) seriously when they definitely should. I am sorry that you had that experience.
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At one time or another I have had a mental health care provider use all of these assumptions on me. You are right, they shouldn’t be made. There is no benefit that I can see in making any of these assumptions, and they can do a lot of harm. Thanks Anja.
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It is so frustrating, isn’t it?! I had a friend who I managed (after many tries) to get to go to the ER after an attempt, and whatever ER doctor or psychiatrist saw him thought he was completely fine to be sent home… right after an attempt & while still being actively suicidal! It was nonsense! Just because someone appears calm, not severely depressed, or not ‘crazy’ does not mean they are healthy or in a safe/non-suicidal state! Ugh!
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I had a similar experience last year. I was hospitalized twice early in the year (having to fight for my spot in hospital each time). Then in the summer I made an attempt and was brought in to hospital to treat the overdose. Basically as soon as I was conscious they asked me questions, and being fearful of another hospitalization I downplayed the severity of it all. They sent me home, the day after a dangerous attempt, just hours after waking up. I know in that moment I pressed to go home, but seriously, what kind of logic was it to let me? Suicide attempts should always be taken seriously.
Likewise I failed to receive services for years when I was more high-functioning. Apparently as a good student in a happy relationship who worked part time my mental illness was less valid or something. It’s incredibly frustrating.
These assumptions can cause a sever in the patient-provider relationship, deter people from seeking further help when it’s needed, and most importantly puts our mental health and lives at risk.
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Thank you so much for sharing your story! I am sorry for what you went through and I hope you are recovering/doing better! 🙂 Suicidality is often not taken seriously. I understand that there may be a high demand for psych beds, but patients in a crisis should not have to fight for treatment. Being too “high-functioning” to be taken seriously is also an issue to which I can relate! Providers should acknowledge that even if their patient manages to do much more than get out of bed, they may not be in a good place (i.e. could still be severely depressed). Lives are definitely at risk when dealing with mental health crises, so this needs to change!
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Thanks! I am doing a bit better. I’m still struggling with suicidality but have better coping tools now to help me get through my thoughts of suicide. I’m fortunate that most of my care team have taken my suicidality seriously and that I am finally receiving services after years of going without treatment.
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