Trust is not the same as belief. I would say that you can trust someone even if you don’t fully believe them, and this lets you consider what they say, even if you decide it’s actually rubbish. Trust does not require blind faith; in fact you often need to discard the latter when trust is required.
In my view, belief is dangerous. I know people who declare that because they remember something, then it must be true. Yet all we remember are memories of what may be memories, it’s quite feasible none of it actually happened. I don’t suggest disbelief as a policy going forward, rather a gentle acknowledgement that we can never be sure.
Trust fits well into this, and I think this is what we, as patients, clinicians and humans should be aiming for. As a patient, I don’t want to feel scared, anxious, ashamed. When I do, I’d rather be able to say these things out loud, but it’s always been difficult. As a psychiatrist myself, I have often felt that people will see the worst in me, if I say what I feel when I’m a patient. And being dismissed by psychiatry for voicing these feelings (or even thinking this will happen) does not inspire trust. It would be far better to ask why, to try to understand, even while disagreeing. It makes for a real, and less repetitive, conversation, as well as making me ask myself why I think this, which is likely to have a more interesting outcome than just denying it.
But trust works both ways – as the old adage says, it’s not just about me. How can a psychiatrist and their patient have a trusting relationship? Current times have led to short contacts, which, while having some advantages, can make it hard to grow a trustful relationship. And how does the psychiatrist trust the patient, particularly when the psychiatrist, like me, is periodically broken. There are times when I can’t really think of my patients, and when I’m not fit to be at work. Yet the idea of my own doctor being ill, or incapacitated in any way, arouses complex feelings. How can I trust them if they cannot be relied on? Yet, thinking as my own doctor, he would probably say – well, it was all fairly straightforward, and someone else can easily manage this – she should trust me.
We probably all trust in different ways, and it’s likely that we all express this differently. Sometimes our lack of trust may be more about the system – when this works well, it can incorporate personalities. However, lack of resources, and a consequent less well functioning system may lead to dependence upon a particular clinician, and a fear as to what will happen if they leave. Dependence, especially in these circumstances, is probably not a good thing.
I’d like to examine my own relationships, as both patient and psychiatrist, over the years, but that would require honesty, another dubious virtue, as well as accurate memory, which I’ve already dismissed. It takes a time to get to know anyone, so if you’re lucky enough to get that, it helps. My last psychiatrist retired suddenly, after I had known him for many years – I’m not sure we trusted each other, but we grew used to our meetings, and what we would say. We were very unlike each other, but I think he helped me, and I certainly think he tried.
It’s interesting, I felt a great warmth towards my new psychiatrist when he said he played the violin, like I do. It’s ridiculous, as we will never hear each other play – but it just seemed that a little bit of him understood a little bit of me, and in a non-psychiatric way. I think it will be quite important for me to keep that bit of knowledge at the back of my mind. More recently, I was wearing some slightly colourful clothing, and it was admired by a patient with similar taste. It made me feel happy, but I had to stop it becoming a bond, and thus interfering with our trust and our relationship.
I’m not saying that these positive things are bad, any more than negative ones would be – just that we mustn’t be fooled into creating imaginary relationships.
People have asked me if I became a psychiatrist to cure myself, and I always deny this indignantly. Yet, I’m not sure if I’m being entirely truthful. I don’t think I did want to cure myself, but I observed these relationships, and this trust, between psychiatrists and patients, including myself. I don’t think I craved those particular relationships – from what I can remember – but I wanted to understand, I wanted to be able to have that trust with my own patients, and with others. Looking back, it’s impossible to say whether what I saw was true, but that was what it seemed like to me.
What is psychiatry about? Mental illness, neurological disorders and disabilities, and ever increasing numbers of problems. But it’s all defined by people and trust and relationships, whether it goes well or badly. And it has to be individual – one person’s heaven might be another’s hell – so we can never make assumptions. I want what I am lucky to have – a psychiatrist whom I can see if unwell – and I think this is becoming increasingly difficult in the current system. Being a psychiatrist myself almost certainly helps me as a patient in some ways – and hinders me in others, for example, I choose not to go ‘out of area’, largely because I don’t like driving. This narrows my options, and I am always aware, attending for maintenance ECT, that I may bump into colleagues. I think all that I can say then is please trust me, and say hello.