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?