When patients share their traumatic experiences, trust that they are almost always telling the truth. We must be empathic and compassionate to build therapeutic connections.
“No one believed me until you,” Ms. J said. She was an elderly patient trapped in a decades-long cycle of probable psychogenic attacks and a list of ineffective antiepileptics. I’d been slowly working on building a trusting relationship with her. When I first offered mental health services, she declined. When I told her I was actually a psychiatry resident, not a neurologist, she nearly upended her breakfast tray: “I knew they thought I was CRAZY! They sent me the CRAZY PERSON doctor!”
Later, she asked, “Can I tell you something? I get scared sometimes. Because someone tried to choke me.” She raised a hand to her throat and fear clouded her eyes. “I think about it sometimes, and I don’t want to. I’m up against the wall and he’s got his hands around my neck. I have no idea how I got out.”
My heart pounded. I saw a silver ceiling light swinging above me, and I felt hands around my throat. Dear God, I don’t want to die.
“Can I tell you something, Ms. J?” I asked. “I understand exactly what you’re feeling.”
She took my hand. “I know. I saw sadness in your eyes when I asked you yesterday if you had a man in your life. I knew something had happened to you.”
Then she disclosed more: a rape, a pregnancy. “My baby’s 60 now. He knows I had to give him up. I was just a child myself. I felt safe telling you. No one believed me until you. Blame the woman—they always blame the woman. Even though he did it to me again and again, the family said it was my fault. And all those doctors—they acted like something was wrong with me. In those days, if it was done to you, it was your fault. But we’re making each other better. You and me, talking. Woman to woman. I wanted someone to tell me he did wrong. I wanted someone to believe me.” I nodded because I understood.
Some, or even many, patients have been traumatized by abusers. Often, they are then retraumatized by the systems that are supposed to protect them and reduced to demeaning labels that devalue: “Not credible. Overreacting. Vindictive. Crazy.” While our larger institutions may traumatize and retraumatize these patients, we as healthcare professionals can refuse to be complicit by drawing on our own sense of empathy and finding a thread of connection. Tell them, “I believe you.” And mean it.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.