Rethinking Trust in Psychiatry: When Mistrust Is Misread as Madness

A new paper in Psychoanalytic Psychology challenges how mental health professionals often interpret patient mistrust. Instead of seeing it as a symptom to be treated, the authors argue that mistrust can be a healthy and even necessary response to a world that has consistently denied a person’s experiences or perspective.

Psychologists Elias Jurist and Matthew Pizziferro focus on a specific kind of trust known as epistemic trust. This refers to the fundamental belief that the information we receive from others is reliable and that our own sense of reality is worth expressing. When that trust is broken, especially through trauma, discrimination, or dismissive clinical care, it can leave people feeling unheard, uncertain, and disconnected from themselves and the world around them.

“Mistrust can be a rational response to oppression,” they write, “not merely an indication of psychopathology.”

The article explores three interconnected concepts: epistemic trust, epistemic vigilance, and epistemic injustice. It highlights how credibility, power, and communication influence the therapeutic relationship. Drawing on insights from developmental psychology, mentalization theory, and philosophical discussions of injustice, the authors argue that many clients, particularly those from marginalized backgrounds, have valid reasons to be cautious.

This paper adds to concerns about how mental health systems often dismiss lived experience, showing that mistrust in clinical settings can reflect a history of being unheard or disbelieved. It presents epistemic trust as something shaped through relationships and experience, and often weakened by diagnostic authority and cultural exclusion.