As a psychiatry resident, I was drawn to this field for a simple reason: We take the time to listen. In a medical system that often prioritizes lab values over lived experience, psychiatry dares to sit with patients and say, “I believe you.”
But before I put on my Patagonia with an embroidered “MD,” I was a patient asking for someone to listen to my health concerns. As a first-year medical student, my later surgically diagnosed health condition was “just medical student anxiety.” I was told the symptoms I had lived with for over 10 years were “all in my head.” A year later, I sat vomiting in the ER hours after an infertility procedure. I was doubled over in pain from — determined later to be — ovarian hyperstimulation syndrome, only to be met with blank stares. “It’s probably just in your head.”
This phrase is an example of what’s coined by the nonmedical community as “medical gaslighting.” The active dismissal of symptoms has haunted many patients, especially women and people of color. Dismissing suffering as hypochondria, drug-seeking, or even malingering. “It’s all in your head” has long been used to invalidate psychiatric and neurological conditions, implicitly suggesting that if something isn’t visible on an X-ray or a lab panel, it must not be real. This mindset is not only incorrect, but also goes against the ethical principle of malfeasance: Do no harm.
Ironically, “all in your head” is quite literally true. The brain is in your head. It is the most complex, powerful organ in the body that through the nervous system regulates the rest of the body. When it malfunctions — whether due to internal miscommunications, chemical imbalance, or external stress — it creates real, physical suffering. Isn’t the point of medicine to prevent and treat such suffering?
We’ve seen this shift happen with addiction. Only when addiction was understood as a brain disease with changes to physiological and molecular communication in the brain, and not a moral failing, did the medical community begin to treat it seriously. Why haven’t we extended that same compassion toward depression, chronic pain, and somatic symptom disorders?
One reason is medical culture. We value what we can see: tumors, broken bones, bleeding wounds. However, mental and neurological suffering is often invisible. So instead of taking the time to listen to our patients’ cries, we dismiss them and move on to the next patient. Ironically, in a system where physicians themselves are burned out and overwhelmed, we are not valuing the pain we each hold. Additionally, empathy becomes more difficult when one is too exhausted and not prioritizing one’s own suffering. When you’re constantly in a fight-or-flight stage, it’s nearly impossible to step into someone else’s shoes. Therefore, we gaslight our patients and ourselves instead of acknowledging the pain.
There’s also a language barrier between patients and physicians that we don’t talk about enough. In medical training, we’re conditioned to think in complex, scientific, technical terms, so much so that we forget how to speak plainly. We assume patients know what we know, even though we have given over eight years of our lives to learn medicine. When they describe symptoms in nonclinical ways or use language that doesn’t match our mental template, we minimize their experience instead of exploring it further. This is how “normal” becomes a weapon. However, what is truly “normal”?
Emily Nagoski, PhD, wrote in her book “Come as You Are” that it is “normal to not feel normal.” Normal is simply feeling that you are not alone in your experience. It’s knowing that someone else has felt what you feel and survived. When you believe your suffering is singular, you begin to think you are broken. That isolation can breed emotions such as anger, shame, confusion, and even despair as people begin to question not just their health, but their own self-worth.
That is why in psychiatry, we are taught to normalize feeling and expressing pain. We don’t minimize it. We sit with patients in their darkest and most painful moments. We don’t look away in shame when tears run down their face. We know we cannot always “fix” their concerns, because sometimes all that is needed is to be a witness to their suffering. That is the art and purpose of medicine.
The truth is: All suffering is real. Whether it’s visible on a scan or whispered through tears, it deserves our full attention. We must reclaim the phrase “it’s all in your head,” not to dismiss but to affirm patients’ humanity. Just as the brain is a part of the body, mental health is a part of overall health. Validation is not just compassionate, it’s clinical treatment.
If we want to rebuild trust in medicine, we must listen, believe, and treat invisible suffering with the same urgency as the visible kind. That begins with never again telling a patient that what they feel isn’t real, because it is to them.
It’s all in their head, and it’s all in your head too. That’s exactly why it should matter to you as a medical doctor.
How can we better validate the unseen in our clinical practice? Share in the comments.
Stephanie Moss, MD, a psychiatry resident, is dedicated to addressing mental health disparities and advocating for individuals with marginalized identities. She hosts the podcast "Life as a Patient-Doctor," which emphasizes the humanity in medicine. Dr. Moss is a 2024–2025 Doximity Op-Med Fellow. Connect with her @medpsycmoss on social media.
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