Thank you so much for this heartfelt article. I am also a physician working for almost 30 yrs primarily with individuals and communities facing structural violence. I echo your sense of being in a system married to neoliberal ideology that chooses to medicalize human suffering and distress. I also teach in the medical system and am continually struck by the free pass that Psychiatry gets in not needing to meet even the basics of scientific practice and the failure to meet our professional and ethical responsibilities in informing patients that the entire discipline is socially constructed. We have never yet found a single biomarker applicable for ‘diagnosis’ or ‘treatment’ as clearly echoed by Drs Allen Francis & David Kupfer Chairs of DSM 4 & 5, despite many decades of research and many millions of dollars. Patients are seldom, if ever, told that ‘diagnosis’ is based only on criteria established by small appointed committees, meeting in camera for years, and merely voted in/out of existence every 15 or so years when a new manual is brought in similar fashion to the largest omnibus bill imaginable. Patients are never told that a diagnosis given can never be removed, contrary to your statement telling patients that your opinion differed from another. Your difference of opinion doesn’t matter; you can only add to diagnoses… you can never subtract. There is no provision in the DSM for that sort of well-meaning endeavour. There is no ‘cure’ for such socially constructed‘diagnosis’. The only potential outcomes once ‘diagnosis’ is given are ‘remission’ (partial or complete) or ‘relapse’. Once ‘diagnosed, you are forever labeled an other, different from other human beings, with your genuine pain, distress, anger, or perceptions being evidence primarily of disease, rather than a body, or a community of bodies, crying out saying something is not okay. It is so completely clear that you genuinely care deeply for the people that come through your door, and that is sadly lacking behind too many medical doors, even if not intentional. But caring is not enough. Our oath is to ‘do no harm’. Science is not a collection of truths, but instead a recognition that as wonderfully fallible humans, we are always biased and always at least partly wrong in our beliefs or understanding. Science is self-correcting as we continue to interrogate what we think we know. I challenge your statement that you ‘believe’ in mental illness. Beliefs are important, but they are not science, and should never be used as surrogates for science. Science is most often misrepresented and misunderstood. It demands humility rather than certainty. I think patients demand a clear and repeated discussion about the lack of biomarker evidence in all of psychiatry. I feel patients deserve to know that they have many options to both understand and respond to their very real and very important human emotional and perceptual experiences. There are times when I tell patients that no one can say why they hear things that others can’t hear, but we can still talk together about options to respond with the humility and caution that we can easily do harm, and always with the persons autonomy front and centre. Reading your article brought me both joy and hope. This kind of difficult professional critique is painful and largely absent in a discipline that understands questioning and criticism as religious heresy rather than a necessary scientific endeavour. But you are in a difficult spot in a profession that demands a pathological ‘diagnosis’ in order for you to be paid. We all must ask then if we are doing harm. Other critical psychiatrists (Sami Timimi, Joanna Moncrieff, James Davies) and others like John Reid, Robert Whitaker, Jan DeFehr, Ariel Joseph, and many others in many other disciplines and movements like Fireweed Collective have continually challenged me and changed how I have come to understand and hope to come alongside other suffering people. I am curious who moves you these days. I am curious what you will do. And regardless where you end up, I am sure that you will continue to care for the people you meet. I’ve written more than intended or needed and I’m sorry for that. I’ll also be watching also for your name in the literature.