The Psychiatric Dichotomy: Why Trauma Stories Are Often Dismissed - And Whether Real Change Is Coming

Many targeted victims who took part in our research describe a frustrating and painful pattern when they relay their stories to mental health services. They share their accounts of trauma, abuse, harassment, surveillance, and organised targeting with the doctors overseeing their care - experiences that have profoundly affected their lives. Yet too often, these stories are not truly listened to and are dismissed. 

Instead, psychiatrists quickly frame them through a diagnostic lens and diagnose the targeted victim as paranoid, suffering from delusions, or another mental health condition. The response? Medication. The targeted victim is then medicated often with little exploration of the person's full narrative or context.

This isn't just isolated complaints. It reflects a deeper dichotomy in psychiatry today: the dominant biomedical model versus growing calls for trauma-informed care.

The Biomedical Default: Symptoms Over Story

Under the traditional biomedical approach, mental distress is primarily viewed as a brain-based "illness" best managed with diagnosis and pharmacological treatment. This model has shaped training, guidelines, and service delivery for decades. In practice, it can mean:

- Short assessment appointments focused on ticking symptom boxes rather than building trust.

- Rapid labeling of unconventional or hard-to-verify experiences (such as reports of targeting or systemic harm) as delusional.

- Heavy reliance on medication as a first-line response, sometimes without addressing underlying adversity or life circumstances.

- Countless victims report feeling invalidated: their reality is reframed as illness, their credibility questioned, and practical support sidelined. This can compound trauma, erode trust in services, and leave people isolated or over-medicated.

The Trauma-Informed Alternative: Listening First

In contrast, a trauma-informed approach starts from the understanding that trauma is widespread and that many forms of distress are understandable responses to adversity - not purely biological defects. Key principles include:

- Prioritising safety, trust, and collaboration.

- Actively listening to the person's story without immediate pathologization.

- Offering support, practical help, peer involvement, and choice - rather than defaulting to medication or coercion.

- Recognising how past harm can shape current experiences, while avoiding re-traumatization.

Advocates, including some within the field and influences from international bodies, argue this shift could reduce unnecessary medicalisation and improve engagement. In the UK, efforts like NHS England's guidance on trauma-informed inpatient care and Scotland's National Trauma Transformation Programme show pockets of progress. Some services report benefits such as reduced incidents of self-harm or restrictive practices when trauma-informed principles are applied.

The Big Question: Can the Profession Adapt?

Here's where the real challenge lies. How would a profession long trained in diagnostic efficiency and risk management cope with a system that puts the person's narrative and lived experience first?

Many psychiatrists and staff are accustomed to structured, time-limited consultations. Shifting to deep listening - especially with complex, distressing, or non-mainstream accounts - requires new skills, longer engagements, and emotional resilience. 

Staff may face vicarious trauma from holding space for repeated stories of harm. In under-resourced NHS settings with high caseloads, short appointment slots, and pressure to meet targets, relational work often feels impossible.

Organisational barriers are also significant: inadequate leadership, staff turnover, resistance to moving away from familiar biomedical frameworks, and the persistence of coercive practices (like restraint) and set ways of doing things all clash with such new empowerment principles. 

Training alone rarely suffices - true change demands wholesale change - a complete, cultural transformation across whole systems, not just a rebranding exercise.

For doctors unused to "putting the victim first", this could feel deskilling or risky. What if listening leads to missing a genuine clinical concern? Liability, guidelines, and ingrained habits all pull toward caution and quick diagnosis.

Will It Actually Happen - or Remain Business as Usual?

Implementation is uneven. Scotland has invested substantially in its National Trauma Training Programme, with frameworks for workforce development and some positive local outcomes. 

In England, NHS documents reference trauma-informed elements, and certain wards or teams have piloted changes with encouraging results. 

Yet widespread evidence shows that "trauma-informed" can become superficial: just language without any real changes in power dynamics, resource allocation, or medication-heavy defaults.

Critics note that deep change stalls due to funding pressures, change fatigue, and the enduring dominance of the biomedical model. 

For targeted individuals specifically, services may still default to viewing reports of organised harm through a lens of delusion rather than verifiable trauma or adversity - creating a persistent flashpoint.

Real transformation would require sustained investment, genuine co-production with lived experience experts (not "fake" experts), accountability for outcomes, and willingness to challenge long-standing incentives.

Without these, many fear it will remain business as usual: stories unheard, medication prioritised, and trust further damaged.

Exploring the Irony

There is an irony to all of this. A doctor can spend many years in rigorous medical training to become a psychiatrist - studying complex human psychology, neuroscience, diagnostics, and therapeutic approaches. Yet if the end result is simply ignoring the patient’s story, immediately diagnosing them as mentally unwell, and reaching for a prescription pad, then what is the real value of all that training?

In practice, this often looks like a mechanical conveyor-belt system: 

Not Listening → Diagnosing → Medicating Up. 

Anyone off the street could sit in a chair and say, "What you’ve described hasn’t happened, you’re delusional, and here are some tablets". It requires no deep listening, no genuine exploration of context, and no meaningful human connection. The years of specialist education seem wasted when the process becomes so formulaic and dismissive.

We believe psychiatry should be far more than this. If the profession truly wants to help people in distress, especially those reporting trauma and abuse, it must move beyond the conveyor belt and start putting the patient’s lived experience at the centre. Until then, the current system risks undermining its own credibility and failing the very people it claims to serve.