Though I’ve spent years studying how medications affect the brain, and proudly consider myself a psychopharmacology nerd, no pill I prescribe can take the place of trust. The most powerful intervention I bring to the table isn’t a drug. It’s a relationship.
Yes, I love medications. I find it fascinating how psychotropics interact with neurocircuitry to relieve symptoms of depression, anxiety, trauma, and more. But this isn’t the heart of my practice, and it wasn’t the core of my training. The cornerstone of psychiatry, and my top clinical priority after patient safety, is the therapeutic alliance.
Despite some progress, stigma around mental illness still runs deep. I was recently listening to The Carlat Psychiatry Podcast, where Dr. Aiken interviewed Dr. Nick Rosenlicht about what’s gone wrong in the mental healthcare system. One part of their conversation stuck with me. Dr. Rosenlicht criticized the trend of referring to people in mental health treatment as “clients” instead of “patients.” His point, as I understood it, was that this language reflects a shift toward framing care as a service, a commercial transaction, rather than a healing relationship. Dr. Aiken responded that the term “client” was meant to reduce stigma and foster dignity. But Dr. Rosenlicht pushed back, suggesting that framing psychiatric care as a business dehumanizes it further. You would never refer to someone in the emergency department as a client.
That point hit home for me. When patients come to see me, my goal isn’t simply to prescribe a medication that might help relieve symptoms. I want to help them get better, yes, but my focus is much deeper than that. My job is to meet them where they are, understand their lived experience, and walk with them toward healing.
Mental illness is widespread in the United States, and millions suffer in silence, weighed down by shame, judgment, and fear. Even when they take the brave step to seek help, many feel unheard, rushed, or dismissed.
This isn’t unique to psychiatry. If you asked most Americans about their last medical appointment, chances are they’d say they felt like just another number. In mental health care, this dynamic can be even more harmful. And while think tanks and policymakers have acknowledged the issue, patients rarely see meaningful change.
One of the reasons I pursued this field was because I’ve been on the receiving end of those rushed visits. I’ve felt like a time slot. Like a task on someone’s checklist. That experience shaped me.
Now, I often meet new patients who are on medications they don’t fully understand. Some don’t know why they were prescribed. Some don’t even know the names. I’ve evaluated women of childbearing age who have been maintained on Paxil or Depakote with no awareness of the associated teratogenic risks. These are not small details. These are essential conversations that should happen long before a prescription is written.
Of course, I can’t fix the entire healthcare system. And I know some patients may see me and decide I’m not the right provider for them. That’s okay. I have no hidden agenda. I don’t need to win anyone over. I just want to be honest, to build trust, and to set a clear foundation for care. Even if the truth is uncomfortable, I believe in saying it.
Trust is everything. Without it, there is no therapeutic alliance. I tell every patient on day one that this has to go both ways. They have to trust me, and I have to trust them. My role as a psychiatric nurse practitioner is about far more than medications. It’s about building a working relationship, one based on honesty, mutual decision-making, and respect.
Psychiatry has changed. We’re no longer in an era where the provider says it and the patient just accepts it. Treatment isn’t about cycling through medications and raising doses until something sticks. Patients aren’t passive recipients. They’re partners. And the provider isn’t a king. My job is to use my training, my clinical judgment, and my passion to co-create a treatment plan that is personalized and adaptable. No two brains are the same. No two stories are the same. No protocol can substitute for that kind of nuance.
The patients we care for are often among the most vulnerable. Many carry trauma, substance use histories, systemic disadvantages, and prior healthcare-related harms. These layers make trust harder to build but more vital to establish.
This is especially true when working with marginalized communities. We all know the statistics. LGBTQ individuals are less likely to seek care, more likely to experience suicidal ideation, and more likely to be denied access to care when they try. The barriers are real and compounding.
I was listening to one of my favorite artists recently, Juice WRLD, who spoke candidly about the mental health stigma he faced growing up, particularly as a young Black man. Before his tragic overdose in 2019, he recorded the track Wishing Well, which includes these lyrics:
This can’t be real, is it fiction?
Somethin’ feels broke, need to fix it
I cry out for help, do they listen?
I’ma be alone until it’s finishedSometimes I don’t know how to feel
Let’s be for real
If it wasn’t for the pills, I wouldn’t be here
But if I keep taking these pills, I won’t be hereI just told y’all my secret, yeah
It’s tearing me to pieces
I really think I need them
I stopped taking the drugs and now the drugs take me
This is the part where I tell you I’m fine, but I’m lying
I just don’t want you to worry
This is the part where I take all my feelings and hide ‘em
‘Cause I don’t want nobody to hurt me
The vulnerability in that verse is heartbreaking. But more than that, it’s revealing. He wasn’t just writing lyrics; he was asking for help. And despite his fame and talent, he died at 21.
Working at the poison center gave me an inside look at these crises. I’ve spoken to terrified adolescents after intentional overdoses, to panicked parents watching their child lose consciousness, to ER physicians looking for guidance as they treat someone in critical condition from a lethal ingestion. These were not abstract cases. These were people, scared, hurting, and often unseen by the system around them.
Mental illness doesn’t discriminate. It affects people across all races, genders, ages, and income brackets. Sometimes, it seems as though providers forget this truth, as if they are somehow immune to the very illnesses they treat. But we know better, and we must do better.
I often think back to my graduate school application essay, where I wrote, “People are suffering and dying, and I have to do something to stop it.” That motivation still drives me.
Every day I go to work, I fight to combat psychopathology with everything I have. I do it for my patients, for those who have lost their battles, and for those who haven’t yet found the courage to ask for help. I do it because I believe in the value of every person who walks through my door.
My goal is to make every patient feel safe. Every patient feel heard. And every patient feel like they matter.
Because they do.
When someone comes to see me, I want them to feel welcome, not judged, not rushed, not like a burden. I often joke with patients that I spend more time in my office than I do at home, so it may as well feel like home. But that’s not really a joke. It’s how I want the space to feel. Comfortable. Grounded. Safe.
If I’ve done my job well, maybe that office becomes more than just a place for appointments. Maybe it becomes a place where healing begins.