Nobody told me to do this: What it means to be a dissident psychiatrist

Before I was a psychiatrist, I was a psychiatric patient.

I remember sitting in waiting rooms, waiting to see the next psychiatrist with a pit in my stomach, not knowing whether my suffering would be seen or heard. Watching as my belongings were searched for sharps, horrified that someone had judged me deviant or deficient enough for this intrusion to be “normal.”

My experience of psychiatric care began during my first year of medical school when a mental health crisis led me to take a leave of absence. While my classmates advanced through to the next stage of training, I fell apart and into the mental health system as a patient.

When I eventually returned, I continued to navigate both worlds at once: learning how doctors and psychiatrists in particular think, diagnose, and treat while simultaneously being on the receiving end of psychiatric care.

As a medical student with a history of “impairment,” I had to be “seen” and to get approval from psychiatrists in administrative roles. They, too, would judge me—this time regarding my fitness to resume my studies. Throughout medical school, I was periodically pulled into offices to answer questions about my “behavior.” Any show of strong emotion, conviction, or dissent against authority seemed to warrant questioning my mental state. I felt constantly judged and often misunderstood. The analysis of my humanity often felt painful and always incomplete.

Thus, long before I became a psychiatrist, I experienced what it felt like to be subjected to medical and psychiatric power. I experienced the disconnect between the tragedy of my life and the routine, automatic nature of the provider—the very worst moments of my life being just another day, shift, or appointment for them.

Some of the most painful jolts I experienced during my early 20s while navigating our mess of a mental health system came from seeing almost entirely White providers. Their grimaces of confusion—when I shared experiences as a daughter of Punjabi-Sikh immigrants. I eventually realized that large swaths of my life were unintelligible—“foreign” even—to the people responsible for helping me. It felt like a setup for being labeled crazy and triggered childhood memories of being punished, misunderstood, or othered by White authority figures.

Being immersed in psychiatric care during these formative years changed everything about how I move in relation to people receiving my own care. I saw how diagnoses and labels can be an indictment of a whole life and how medications can have reverberations far beyond their biochemical properties.

I made people’s stories—rather than the DSM—my Holy Grail.

I also refused to let someone’s worst day of their life become routine on my end.

Eventually, I learned to remove certain psychiatric interventions—physical and chemical restraint in particular—from my practice entirely because I came to believe they do more harm than good. And I felt inspired to develop the kinds of antiracist standards that had been completely absent from my own care.

I will not do to others the things I would not want done to me.

The seeds of my dissidence were planted there.

But what does a dissident psychiatrist look like in practice? What follows is a case history of a teenage forensic patient of mine.

“Who Told Her to Write This?”

The judge asked me this after reading my twenty-page, single-spaced forensic child psychiatry report.

Though it highlighted DSM diagnoses and employed clinical jargon, at its core it was meant to throw blood on the court’s hands. A scathing indictment of the criminal justice system that had assailed a teenaged Black boy during the most formative years of his development under the guise of “safety.”

He had been caged in juvenile detention for years. He deserved to be free. None of the diagnoses assigned to him—oppositional defiant disorder (ODD), attention deficit hyperactivity disorder (ADHD), and more—could capture what the school-to-prison pipeline had done to him.

In the report, I leveraged my credentials to provide cover for what needed to be said and to ensure that his suffering would not be dismissed. Board certifications, degrees, and publications.

But that’s not the version of myself that told me to write it. It was the version that felt my humanity tied up in his. The one who understood that even where I do not share your struggle—and I carry privileges and a differing social positioning—as your provider, I am still responsible for shielding you.

Nearly twenty years had passed since my breakdown. I had completed four years of medical school and nine years of post-graduate training in adult psychiatry, global mental health, and child psychiatry. As I learned how psychiatrists were trained to think, I never stopped seeing the profession through the eyes of someone who had experienced the many shortcomings of its care.

The countless gaps in knowledge and advocacy that had harmed me firsthand, I then watched harm thousands of others. Seeing the fallouts of those gaps in rural Haiti, where I worked for two-and-a-half years left an indelible mark. The biomedical model’s erasure of history, structural violence, state violence, and the life-or-death stakes that come with people not surviving on a dollar a day became impossible to ignore.

Psychiatric diagnosis and intervention, when divorced from context and probing medical and psychosocial evaluation, can become dangerous. In Haiti, I watched agitation from underlying medical conditions mistaken for psychiatric disease. One misdiagnosis, one poorly considered sedative, one failure to see the whole person could alter the course of an entire life or even end it.

It was there that I learned that people cannot be understood apart from history, culture, family, community, violence, and relationships. Caring for someone requires bringing your whole mind to bear on their suffering—but also your heart. When life and death hang in the balance, there is no substitute for context and no alternative to adept advocacy.

Nobody told me to do it. I told myself.

Halting the Assault

I had been assigned to be his outpatient child psychiatrist several years earlier.

When I first met him, he struck me as being a sweet boy. Handsome, tall—with a strong physical presence, but his head hung low. Fatigued to the bones, he spent all day playing video games—the telltale sign of a shutdown teenager.

He was a musician, a poet really, and crafted rhymes that had caught the ears of more than a few music producers in the community. He was kind and caring towards his younger siblings.

His teachers had been saying the same thing for years. Across record after record, the portrait was consistent: respectful, kind, polite, and a strong record of success with trusted adult supports who saw his strengths, rather than punished his limitations.

And yet.

He had never received care that met even the lowest threshold of standards for his diagnoses.

Despite the support of a few select teachers, school had never been a place of learning or belonging. It had been a place of assault. You are the problem. It is always your fault. You will always be punished and denied the benefit of the doubt.

It made sense to me why he’d want to stay home and smoke cannabis all day.

Like many of the Black and Brown “delinquent” kids I have seen, he was sensitive and prone to anxiety. He recognized the assault and felt it deeply.

He carried early childhood trauma—in his case, an older brother who served as a father figure, shot and killed by the police. There were learning challenges too, ones that had never been formally diagnosed or addressed with an educational plan.

He had been denied the most basic, legally mandated educational accommodations for his disabilities and then harshly disciplined for his distress related to this neglect.

He had attended majority-white schools where, like so many Black boys, any sign of emotional discomfort was read as acting out. Suspensions and expulsions followed. A middle school principal terrorized him.

Skipping classes—because of how school made him feel, because it was safer not to be there—became truancy charges, funneling him into juvenile detention throughout high school.

These practices criminalized and traumatized him, catapulting him down the school-to-prison pipeline.

After being charged with two felonies several months earlier, he was sent to a locked residential facility across state lines. He ran away three times.

Whenever kids run away like this, I worry about abuse, which can be rampant in such facilities.

The second time he was on the run in the streets for weeks. When the police picked him up, they threw him back into juvenile detention. I would later learn he had been sexually assaulted by a police officer years earlier.

He was on the run, not because he was delinquent, but because he was fleeing his assailants.

It was then—when he was back in juvenile detention—that two mental health providers, as part of a state-mandated process, recommended he be sent away. Back to the out-of-state facility he had already fled multiple times.

They did not consult me, the provider who had spent the most time with him and his family.

How I Learned to See What Others Missed

Long before psychiatry, I had been trained as a historian. As a history major at Duke, I spent hours in the Perkins Library Special Collections, white gloves on, sifting through centuries-old records tracing the separation of Black and White churches in North Carolina after the Civil War. I learned early that institutions carry history forward long after people forget. U.S. history classes were the place I felt the most at home and understood, perhaps because it gave me the frameworks and chronology to make sense of contemporary moments.

At the same time that I was learning biochemistry and neurotransmitters—the microscopic workings of the body—I was also learning to see the macro forces that shape human lives.

Medical school taught me to look under the microscope. History taught me to zoom out. Clinical care requires both. Perhaps this sensitivity to rupture was older still.

My father was born in Punjab in 1947, on the eve of Partition, one of the largest forced migrations in human history. Punjab sat at the center of the violence that followed, as communities that had lived alongside one another for centuries were suddenly divided along religious lines. Muslims to Pakistan, Hindus and Sikhs to India. People often traveled by foot or by train with hundreds of thousands massacred along the way.

When I once asked my father how Partition had affected his family, he recalled only one thing his father ever said about it: “I wish I could have saved more people.”

Only one Muslim family remained in their village. Many more had been there before.

What happened to the others?

The word “Partition” never came up once in the years of mental healthcare I received. Other words like bipolar, borderline, and depression often did. Historical trauma, colonization, and structural violence were less important than lithium, CBT, and family therapy. No one in those rooms ever asked what my family had survived, only what was wrong with me.

Over time, I came to recognize family separation as a recurring technology of power. History taught me that institutions repeatedly fracture families in the name of safety, civilization, protection, or progress. Slavery. Colonization. Boarding schools. Child welfare. Juvenile detention.

None of this appeared anywhere in my medical training. And none of it appeared anywhere in this child’s chart—the same child whose aunt had already raised him once after his family was separated, who was now being recommended for separation again. No one drew the line from slavery to family policing to a teenage boy being sent back to a place he had three times fled.

The names change. The logics endure.

Family Separation is Not Medicine

When I saw what the other mental health providers recommended, I decided to write the report myself. I worried he might die if he got sucked further into the justice system.

“Further family separation would heighten his trauma, increase his risk of suicide, and make future flight more likely.”

I spent more than forty hours on it. I reviewed hundreds of pages spanning more than a decade of his life. I interviewed his aunt for four hours across three separate calls. I used perhaps ten hours of clinic time—the rest came out of my own life, my own month, my own conviction that somebody had to account for what had actually happened to this child.

I did not ask this child to labor further for the sake of this report. I had everything I needed in the story that had already been told—through his records, his aunt, and himself. He trusted me to care for him. I did not advocate for more mental health services. I simply spent more time working on this child’s behalf and seeking to understand his story.

“The most basic standards of mental healthcare have never been met.”

“What has long been treated as misconduct is more accurately understood as distress—and as evidence of systems failing to care for him.”

“He flourishes when adults see his strengths rather than punish his limitations.”

“His primary caregiver must remain the focal point of care. Further separation would predictably deepen trauma and undermine treatment.”

“He stands at a crossroads: the cycle of punishment and separation could continue, or a new pattern of healing and family-centered care could begin.”

I was not trying to save him. I was solely focused on interrupting the assault already underway.

The judge dropped the charges. He went home. It wasn’t a perfect ending. In many ways, various systems washed their hands clean and took no responsibility for redressing the harms done. However, at least he went home.

What Psychiatry Asked Me to Forget

Psychiatrists are trained to cultivate a certain kind of distance—to maintain a blank face and to refrain from sharing anything personal. We are even taught not to have photographs of our families in our offices. Who I am as a person is not supposed to live in my care.

But I have come to believe that this, too, is a kind of forgetting. Forgetting that doctors are human beings with histories and limitations. Forgetting that patients do not arrive as diagnoses, but as someone’s child, sibling, parent, partner, or beloved. And forgetting that there is no such thing as an encounter untouched by power.

Reckoning with my own story became the vehicle for reckoning with my profession—and with what psychiatric care does to the people we care for. Remarkably, no aspect of my training or professionalization required me to do this.

In some ways, I had no choice. Before I was a psychiatrist, I was a patient. Before that, I was the daughter of Punjabi-Sikh immigrants whose family lived in the shadow of Partition. I was a child trying to make sense of being misunderstood. Later, I became a historian searching archives for the afterlives of slavery and a physician witnessing in Haiti what happens when history, poverty, and structural violence are mistaken for pathology.

I became a better psychiatrist not by becoming more detached from myself, but by excavating myself. Psychiatry taught me to search for symptoms and diagnoses. My own life taught me to search for history and stories.

The more honestly I have reckoned with my own story—warts and all—the more capable and responsible I have become of understanding the suffering of others.

The things no one taught me in medical school and the things no one brought up in my own psychiatric care are precisely the things I am practicing and teaching now. History, culture, migration, power, oppression, family, ancestry, survival, self-reflection, atonement. The gaps have turned into guidance.

I no longer accept the biomedical model as psychiatry’s dominant narrative. Biology matters. But so do history, poverty, racism, culture, family, and power. The question is not simply what is wrong with a person, but what happened to them and what we can do to protect them from harm.

I sometimes catch myself saying “my patient” and stumble over the phrase. It no longer feels quite right. Not because I am any less of a psychiatrist, but because care has never been a one-way exchange. This child shaped me perhaps even more than I shaped him. These are people in my life and part of my community.

I have lost count of the number of times I have apologized for what my profession has done to people—and especially to children. For the times we mistook distress for disorder, punished instead of protected, medicated instead of listened, and separated families in the name of treatment.

Eventually, I left formal psychiatric institutions entirely—not as an abandonment of care, but as an attempt to practice it differently. With a protective stance and an historically oriented approach. The kind of care I needed and never received—and that I want others to receive so they may be spared some of what I went through.

Nobody told me to do this. I told myself.

 

 

This article was first published on Mad In America.