A Psychiatry of Permission

There is so much shame wrapped up in the decision to see a psychiatrist.

By the time someone finds their way to me—whether in an inpatient unit, a private consult, or a quiet ketamine session—they often carry a heavy internal narrative: "Something is wrong with me. I’m broken. I failed to manage this on my own."

And that story didn’t come from nowhere. It came from systems that pathologize pain, diagnose survival responses, and teach people to mistrust their own minds. It came from the reductive messaging that mental illness is just a "chemical imbalance" and that psychiatry only exists to prescribe pills from Big Pharma.

But there is another way to approach this work.

A slower way. A more relational, more curious, more human way. A way that doesn't begin with a diagnosis, but with presence.

Sometimes that looks like pausing before jumping into symptom checklists. Sometimes it means asking, genuinely:

• What do you care about?

• What’s something that’s gone well this year?

• What’s one thing you’re proud of that no one asks about?

  
  

These aren’t groundbreaking questions, but in a psychiatric setting, they can change everything. They remind people that they are still a person—not just a patient, not just a crisis.

Yes, I prescribe medications when they help. I also ask about gut health, sleep, trauma, relationships, and food. But what I hope I offer—beneath all of that—is space.

Not to fix anyone. But to hold room for them to be more than what they're going through.

Diagnosis can be useful. Language can be clarifying. But when we start to believe that our diagnosis is all we are, it becomes a trap. It flattens something mysterious and alive into something clinical and fixed.

I think psychiatry could be something else. Something more generous. Something that says:

• You are more than your crisis.

• You don’t have to feel better to be worthy of care.

• You are allowed to change.

  
  

And maybe this approach isn’t only for those we serve. Maybe clinicians need it too.

Permission to be human. Permission to listen more than solve. Permission to practice in ways that feel true, not just efficient.

A psychiatry of permission doesn’t promise a fix. But it might offer something quieter, and just as powerful: A way to feel seen without having to perform your pain. A way to return to yourself. A way to begin again.