It’s a scenario I’ve become all too familiar with as a psychiatry resident: a patient enters my office already certain of their diagnosis. They’ve consumed a multitude of videos, followed mental health figures on Instagram, and completed online quizzes that “validated” their suspicions. They believe they have ADHD, or autism, or borderline personality disorder. They’re not seeking an evaluation; they’re seeking affirmation.
On one side, this scenario feels like advancement. Social media has ignited a cultural transformation where mental health is no longer shrouded in shame. More individuals are pursuing help, openly discussing their challenges, and advocating for support. That aspect is undeniably positive. The stigma is diminishing, and for far too long, that stigma rendered people silent. However, there’s a troubling aspect as well, one that’s difficult to discuss without being misinterpreted. In a time when content creation is currency, psychiatric labels have morphed into hashtags. Complicated conditions are simplified into brief checklists, and symptoms are extracted from their context. The nuance and diligence of a thorough evaluation, which we dedicate years to mastering, frequently gets overshadowed by algorithms that favor confidence over precision.
This presents a peculiar and sensitive dilemma. When an evaluation does not affirm the diagnosis a patient is convinced they possess, it doesn’t merely result in disappointment; it can lead to mistrust. The clinician becomes the gatekeeper obstructing access to a community the patient already feels they are part of. Occasionally, patients depart believing we are mistaken. At times, they cease attending entirely.
Compounding the issue, the system we operate in often predisposes us to failure. Insurance providers advocate for shorter appointments, quicker turnarounds, and endless paperwork. There’s seldom enough time to engage with a patient’s complete narrative, let alone sort out where social media concludes and psychiatry begins. It frequently seems as if we are expected to perform intricate, nuanced work in a system built for speed and volume. That strain not only exhausts healthcare professionals; it also adversely affects patients.
For trainees, this realm of algorithm-driven self-diagnosis adds another layer. We are still cultivating confidence in our clinical judgement while continually striving to demonstrate our place in the environment. They never informed us that imposter syndrome would be our most constant companion. When patients arrive convinced they have a specific diagnosis, quoting symptoms directly from TikTok, it can provoke a quiet anxiety: What if they’re right and I’m the one overlooking something? Even when every instinct, supervisor, and DSM guide indicates otherwise, that small voice of self-doubt is eager to interject. Balancing humility with authority is a subtle skill, best refined with coffee in hand.
There’s also a kind of emotional rollercoaster in these interactions. Patients come equipped with certainty, while we approach with curiosity and a frustrating tendency to say, “Well, it depends.” It can be disconcerting when the very skill we are still mastering, how to unravel complex psychiatric presentations, is confidently asserted by individuals outside the profession. Yet, that discomfort can be oddly beneficial. It compels us to slow down, enhance our reasoning, and remember that effective psychiatry isn’t about being the loudest voice present. It’s about being the most considerate one.
The issue is further exacerbated by a wider societal atmosphere where misinformation spreads faster than truths and doubt towards institutions, including medicine, is deeply rooted. We have witnessed how perilous this can be with vaccines. Psychiatry is no exception. Still, I maintain that a path forward exists. It begins with humility, acknowledging that our field has not always excelled in listening to patients or affirming their experiences. It also necessitates clarity, aiding individuals in grasping the distinction between self-awareness and diagnosis, between exhibiting symptoms and having a disorder. And it requires presence, dedicating time to converse, to clarify, and to be inquisitive rather than dismissive.
Because ultimately, people aren’t visiting because they wish to manipulate the system. They arrive because they’re in distress and seeking answers. Social media may influence their inquiries, but it’s our responsibility to assist them in finding grounded, evidence-based, compassionate solutions. We aren’t here to regulate identities; we’re here to facilitate healing. And in an era where the internet continuously communicates, our capacity to genuinely listen has never been more crucial.
Anadil Coria is a psychiatry resident.