When your psychiatrist ghosts you

Earlier this year, B had a depressive bipolar relapse together with suicidal ideation. "This was the first time I got suicidal in my life, and I desperately needed my psychiatrist's help," she says. The psychiatrist confirmed that she'd arranged follow-up appointments, but she never got back to B, nor prescribed her the necessary medication.

"I had zero energy to chase her after this," B says. "So I was left, ghosted, alone in the midst of a crisis that could have ended with my death."

B, who lives in Belgium, was one of a handful of people who told me their story after I posted on social media that my psychiatrist had gone incommunicado and asked if others had had a similar experience.

A fair bit has been written about therapists ghosting their patients and the shock, frustration, anxiety, resentment, and sadness this could cause for the patient. Patients have also reported blaming themselves for the abandonment – "maybe I was too difficult for my therapist". Such experiences could derail treatment and scar one's faith in therapy.

In contrast, beyond the odd Reddit thread, there's almost no conversation on what happens when psychiatrists stop responding to patients, cutting off access to critical medication, or, as in B's case, pushing them towards something more dire.

I found this silence strange and decided to investigate.

When my psychiatrist vanished

My latest psychiatrist was my fourth in 10 years. The one before him had saved my life after another one had left me an overdrugged wreck. I was sad to lose him when I moved cities (he only saw patients in person), and it took me a long time to find the energy to look for a replacement.

In the interim, my OCD symptoms, particularly around travel, turned rabid. I feared that a faceless enemy was going to put contraband in my luggage, or rig a hidden camera in my hotel room. I'd tear open my bags at the airport check-in counter. I'd inspect every bulb holder and smoke detector in the room. I'd often feel depersonalised, as if all this was happening to someone else. This was a busy travel year for me. Through endless flights and car journeys, my paranoia sat on my shoulders like a rucksack full of soaked, musty winter jackets. I felt helpless, suicidal.

I ventured all this information to the new psychiatrist – recommended by my therapist – at our first online meeting. He seemed kind and attentive, even sought my opinion before writing up the prescription. I was relieved and didn't mind that he'd shown up to our appointment three hours late.

The first jolt came a few days later. I was about to travel to the US for a conference and found out that I'd be transiting through a region that has strict rules about carrying psychotropic medicines. I needed a letter from my doctor in case airport security wondered why I had multiple strips of mood stabilisers on me.

I texted him once, twice, but got no response. My brain promptly started catastrophising. I told my wife that I wanted to wriggle out of the trip altogether and pay back the airfare to the organisers. Eventually, a member of the Sanity community and one of my mentors helped me with the documentation. But that one week before the trip was hell.

I don't expect healthcare professionals to be available 24/7; my therapist has often admonished me for not reaching out even during emergencies. Was a simple letter too much to ask for, especially since my doctor knew how badly travel triggered me?

Despite the disappointment, I... understood. Maybe he was sick himself. Maybe he had a family emergency. Maybe he had to tend to patients who needed him more. I hoped that he'd reply, even if it was a month, two months later. But the reply never came. Still, a part of my brain continued to make apologies on his behalf. Who knows, maybe he had turned on the 'disappear' settings on WhatsApp and never saw my messages?

I told my therapist I didn't want to see him again. But my symptoms worsened, and I had not choice but to swallow my anger and return to him. Once again, he was calm – a bit too calm. When I hesitantly brought up how the lapse in communication had affected me, he didn't so much as acknowledge it. He felt I should start on lithium, but first I needed to get a kidney function test since lithium can cause renal complications. I did and sent him the report – and was again met with radio silence.

Around this time I also decided to join the gym. It took me a lot of self motivating because I hate gymming. The gym instructor said I needed my doctor's clearance before enrolling me. This request too went unanswered.

So now, I'm stuck. I haven't been able to start on lithium, and I've been avoiding the gym instructor's calls and messages. My therapist apologised for the mess and offered more references, but I told her I am not ready to go down that road again. I've asked myself if I'm being plain lazy. How hard could it be for my privileged ass to find a new doctor?

Except I know what I really am is deflated. Robbed of momentum. Momentum that anyone with a glitchy brain will know is so hard to garner. When you lose that momentum, you lose trust, you lose hope... even if you are super privileged.

"Does that really happen?"

When I posted my story on Instagram, one person said: "Does that really happen?" It made me wonder whether what happened to B and me was an aberration.

H, a doctor in a mental health institution in north India and a service user herself, confirmed it wasn't.

"I've often felt ghosted by psychiatrists during times of crisis," she said. "While there’s a common narrative to 'reach out', it’s a misconception that reaching out will automatically make things better. In some cases, it can actually lead to retraumatisation. When consulting a private or even government psychiatrist, patients often lack proper access to contact their doctor directly (which I understand, given professional boundaries). Even when we manage to reach them, many respond by advising us to 'go to the nearest emergency department'.

"However, many mental health professionals, both psychiatrists and therapists, don't realise that emergency staff are often not equipped to handle mental health crises appropriately, and their interventions may sometimes worsen the situation. Speaking both as a service user who’s personally experienced this and as a doctor who has been posted in emergency settings, I’ve seen firsthand how poorly handled situations can escalate an already critical moment. In many such situations, a psychiatrist simply doesn't provide the adequate crisis management by a simple referral, and the patient might feel ghosted."

Why then don't more people talk about it? My guess is that as a culture, we are used to high-handedness from doctors.

Even if you keep aside extreme professional transgressions like ghosting a patient, we've become okay with 'minor irritants' like waiting for hours beyond our scheduled appointment time. Inordinate wait times are in fact a sign of how reputed (and expensive) a doctor is. Far from complaining, you're just happy that you have a doctor, considering 75% of people in low- and middle-income countries with mental, neurological, or substance use disorders can't access basic care. (To be fair, the situation isn't much better even in the 'first world', where getting a psychiatrist's appointment can take a year or more.)

Think about it for a minute. Would you accept this kind of experience from your therapist, no matter how reputed they are?

Would it be okay if your therapist was habitually late, abandoned you during crisis, and never even acknowledged the issue?

Would you exonerate them because you understand how stressed out and harried they must be handling so many patients?

Why is it that we expect our therapists to be punctual, professional, and available, but give our doctors so much leeway? Doctors are healthcare professionals. So are therapists. Doctors save lives. So do therapists. Why aren't they subjected to the same professional standards?

None of this is a blanket accusation against all psychiatrists. In a broken, under-resourced healthcare system, even the most well-meaning doctors struggle to show up in the way their patients need them to. But the least the profession can do is acknowledge the problem and accept accountability.

Rupinder Legha, a psychiatrist based in Los Angeles, did. "As a psychiatrist myself, my head is hanging," she replied to my story. "This is egregious. On behalf of the profession, I am so very sorry. To say we need to do better is completely insufficient."

We don't know each other, but her words healed a part of me.

What happened to B? "At the moment, I'm still with the same psychiatrist, but I've included my close circle to follow her when urgent support is needed," she told me. "I cannot easily replace her because of the circumstances in Belgium. And because of my deep respect for her academic knowledge and the fact that I'm learning useful new things at every appointment."

Perhaps that combination of pragmatism and hope is what I need to resume my search for a psychiatrist. I will let you know how it goes. If this piece resonated with you, write to me and I will share your thoughts in a future edition.

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