Letter from Your New Psychiatrist

Dear Teen Patient,

If you are reading this letter, then your first appointment with me has been scheduled. I look forward to meeting you in person and getting to know you and your circumstances as fully as possible.

I wonder, what is your suffering like? Perhaps your mood is rock bottom. Or is it irritable, worried, enraged, swinging, or shameful? Are your thoughts on overdrive, paranoid, or screaming at you that you’re a worthless piece of crap? Are painful memories hijacking you without warning? Are you having sleep difficulties? Are you drinking or drugging? Are you refusing to eat or making yourself throw up? Are your grades slipping or are you terrified of getting less than an A+? Are you getting into fights—verbal or physical? Are you cutting yourself? Wanting to disappear or kill yourself? Or maybe you are suffering in other ways.

I don’t know you yet, but I do know that your symptoms of suffering are not a result of psychiatric diagnoses. Did you know that those diagnoses do not actually exist? They are a construct to label clusters of symptoms. Besides offering people the first glimmer of validation of their suffering—and being utilized by health insurance companies to determine payment decisions and by schools to guide student accommodations—psychiatric diagnoses are otherwise mostly useless to suffering individuals.

Let that sink in for a moment.

Now, imagine if after a mere fifty minutes or less of talking with you, I branded you with the psychiatric diagnoses of, let’s say, Major Depressive Disorder and Generalized Anxiety Disorder. Not only would my ability to consider other things in your life automatically be limited, but it might be difficult for me to relate to you as a human full of complexities. I might discount things you described that did not fit your “diagnoses” and pay more attention to those things that did. You might leave my office disempowered by the false narrative of being flawed with mental disease.

Let me be clear: you are not flawed with mental disease. Your genes don’t code for your symptoms. While genes can predispose people to developing symptoms if environmental interplay encourages it, no single gene on its own has been proven as causative of “psychiatric diagnoses.”

There is, however, strong scientific evidence that emotional invalidation from experiences during childhood and teenage years—even without abuse and neglect—causes damage to developing brain structures and functioning, and this damage manifests as symptoms of suffering.

Your symptoms of suffering are a biological response to something external.

Let that sink in for a moment.

Now consider this: as one or more of a myriad of possible emotionally invalidating experiences (such as being bullied, living through family turmoil or parental conflict, being subtly and constantly gaslit, controlled, or belittled by adults or peers, or being shamed or groomed by trusted adults) damages your developing brain, not only do symptoms of suffering appear, but healthy interpersonal attachments are thwarted, your true thoughts and feelings remain elusive, and growing into your authentic self is impossible.

So, when you step into my office and take a seat on the black leather couch across from me, I won’t diagnose you. Rather, you and I will begin with a discussion of your symptoms of suffering and your life circumstances. Together, we will take a long, hard look at what is happening and what you are witnessing at home, at school, with your friends, and with all the relevant people and situations in your life. We will unpack how aspects of your relationships and experiences might—with or without intention—be causing you harm and emotional invalidation.

Our work together will not result in you playing the victim to your experiences or blaming anyone. Instead, you will come to understand that your symptoms of suffering and negative patterns of existing in the world did not develop in a void but as a response to the dysfunction in your surrounding system. You will begin to comprehend that since you aren’t flawed, healing doesn’t fall solely on your shoulders and is a process that involves both you and the system you are growing up in.

Daunting as this may seem, you won’t have to go through it alone. I will be with you every step of the way. I will teach you how to identify and distance yourself from your hardwired symptoms of suffering so you can learn how to think, feel, and act as your authentic self. You will learn how to and practice determining and asserting your true thoughts and feelings, setting appropriate boundaries with people and situations, pulling yourself out of past and future tripping back to the moment, rationally responding to interpersonal challenges instead of reacting, and emotionally validating yourself without the need for external reassurance. And that is just the tip of the iceberg.

Eventually, your agency and confidence will bloom, even if the people in your surrounding system refuse to make all of the necessary healing changes we point out to them.

I can’t wait to begin guiding you on your healing journey. See you soon.

Best wishes,

Sonia Patel, M.D.

Sonia Patel is a psychiatrist and author of the Morris Award finalist Rani Patel In Full Effect and In the Margins Book Award winners Jaya and Rasa: A Love Story and Bloody Seoul. Her fourth YA novel, Gita Desai Is Not Here to Shut Up, will be published September 2024.