Beyond the Interview | A commentary by Dr. Teralyn Sell, PhD
What my conversation with Nicole Lamberson revealed about psychiatric prescribing, cognitive dissonance, and the responsibility to question what we think we know.
I’ve been thinking about something from my conversation with Nicole Lamberson on The Gaslit Truth Podcast.
Nicole is a physician assistant who experienced severe psychiatric medication withdrawal after years of prescribing practices that, by her account, left her increasingly unwell. Her experience eventually led her into deprescribing education and advocacy.
There was plenty to unpack in her story. The polypharmacy. The withdrawal. The difficulty finding appropriate care. The way her symptoms were repeatedly interpreted through the lens of psychiatric illness.
But one part of our conversation stood out to me.
How does someone spend years becoming highly educated in medicine and then become unwilling to question what they learned?
Because that is where this becomes a conversation about something much bigger than psychiatric medication.
It becomes a conversation about judgment.
Being educated and thinking critically are not the same thing
Nicole described her medical education as heavily focused on what medications treat, how effective they are, and what adverse effects to watch for.
What she didn’t receive, she explained, was meaningful training on how to recognize complicated withdrawal or safely help someone discontinue psychiatric medication.
That is a significant educational gap.
But I raised another question during our interview.
What happens when the information is available?
When patients are reporting problems. When published research raises questions. When deprescribing guidelines are available. When there are legitimate reasons to reconsider an established practice.
Why isn’t curiosity the next logical step?
I don’t expect every professional to know everything. That would be absurd.
I do expect professionals whose work is grounded in research to remain willing to examine research that challenges their assumptions.
A degree demonstrates that someone completed an educational process. It doesn’t guarantee that their judgment will remain accurate indefinitely.
Cognitive dissonance is uncomfortable. That doesn’t make it evidence.
Nicole brought up cognitive dissonance, and I think that is one of the most important psychological concepts in this entire conversation.
Imagine spending years prescribing a medication because you believe it helps people.
You’ve studied it. You’ve recommended it. You’ve reassured patients about it.
Then someone presents information suggesting that some patients may experience serious, persistent problems that weren’t adequately considered.
Now you’re facing two competing ideas.
You believe you’ve been helping people.
You also have information suggesting that some of your decisions may have contributed to harm.
Those ideas are difficult to hold together.
And this is where people can become defensive.
It’s easier to question the patient. Easier to dismiss an unfamiliar reaction. Easier to assume the underlying illness has returned.
But discomfort with new information doesn’t tell us whether that information is correct.
Neither does the strength of our professional identity.
The question isn’t whether the evidence threatens what we believe. The question is whether our beliefs can withstand examining the evidence.
Good intentions don’t settle the question of harm
One thing I appreciated about Nicole’s perspective was that she didn’t automatically assume clinicians were intentionally misleading patients.
She described how training, institutional expectations, and limited awareness can shape prescribing decisions.
I agree that intention matters when we’re trying to understand behavior.
But intention doesn’t establish the outcome.
A clinician can sincerely believe a treatment is appropriate and still be mistaken about what is happening to a particular patient.
A patient can experience worsening symptoms without those symptoms necessarily representing worsening psychiatric illness.
And a treatment that benefits one person can create significant problems for another.
Those possibilities deserve examination.
I also think we need to be careful about moving too quickly in the opposite direction.
A patient’s report of harm deserves serious consideration. It doesn’t automatically establish causation. Symptoms may have several explanations, including withdrawal, adverse drug effects, recurrence of an underlying condition, or unrelated medical problems.
The responsibility is to investigate those possibilities rather than prematurely settle on the most familiar explanation.
That’s what sound judgment requires.
What happens when the treatment becomes the explanation for everything?
Nicole described being prescribed additional medications as her functioning deteriorated.
She also described how different professionals interpreted her symptoms according to their own specialties.
In psychiatric care, her symptoms were attributed to mental illness.
In a detoxification setting, her difficulties were interpreted through an addiction framework.
Her own account of medication withdrawal struggled to find a place in either interpretation.
That raises an important question.
If medication-related harm isn’t among the possibilities you’re considering, how would you recognize it?
This isn’t an argument that every psychiatric symptom is medication-related.
It’s an argument against narrowing the explanation before examining the evidence.
The distinction between physical dependence, addiction, withdrawal, adverse effects, and recurrence of illness matters.
These are not interchangeable concepts.
Confusing them can change how a person is treated, how their symptoms are documented, and what options are presented to them.
And once an explanation becomes embedded in the medical record, it may influence subsequent decisions.
That is a downstream cost worth considering.
The part about the FDA that surprised me
I asked Nicole about her involvement in developing benzodiazepine tapering guidance through a project funded by the FDA.
Given her personal experience, I was curious how she approached working within a system she had reason to question.
Her answer was more nuanced than simply rejecting the institution.
She described entering the process with measured expectations, recognizing the limitations, and participating because she believed patient involvement could improve the final guidance.
She also explained that the resulting recommendations did not reflect everything she had advocated for.
I think there’s something important in that distinction.
Criticism doesn’t have to mean refusing participation.
And participation doesn’t require unquestioning agreement.
You can recognize shortcomings in an institution while contributing to improvements in its work.
That requires a different kind of thinking than automatically trusting or rejecting everything associated with an institution.
It requires evaluating the actual decision, evidence, and outcome.
Informed consent requires more than a list of side effects
When we discuss informed consent, the conversation often focuses on whether patients were told about potential adverse effects.
That’s necessary, but it isn’t the entire issue.
They need to understand that short-term improvement doesn’t necessarily establish long-term benefit.
They need to know that a medication’s effects can change over time.
And they need enough information to participate meaningfully in decisions about their care.
This applies whether someone is considering starting medication, continuing treatment, or discussing a possible reduction with their prescriber.
None of these decisions should be reduced to a slogan.
Medication is neither automatically the answer nor automatically the problem.
The relevant question is whether the decision reflects an adequate understanding of the potential benefits, harms, alternatives, and uncertainties.
What stayed with me after the interview
Nicole’s experience was severe. It should not be treated as representative of every person who takes psychiatric medication.
But the severity of her experience isn’t the only reason the conversation matters.
What stayed with me was the issue of professional judgment.
How do we respond when information challenges what we already believe?
Do we become curious?
Do we examine the competing explanations?
Or do we defend our existing understanding because changing it would require acknowledging that we might have been wrong?
This is not a problem unique to medicine.
It’s a human problem.
But when someone holds professional authority over decisions that can affect another person’s health, the consequences of that thinking become much more significant.
Expertise should make us better at evaluating uncertainty, not more resistant to it.
That’s what I took away from my conversation with Nicole.
And it’s a question I think every profession grounded in evidence should be willing to ask.
About the Interview
This commentary follows my conversation with physician assistant and deprescribing advocate Nicole Lamberson on The Gaslit Truth Podcast, co-hosted with Therapist Jenn Schmitz.
We discussed psychiatric prescribing, polypharmacy, medication withdrawal, medical education, patient autonomy, and the challenges of recognizing medication-related harm.
Watch or listen to the full episode: What Nicole Lamberson Learned About Psychiatric Prescribing Changed Everything.
Dr. Teralyn Sell, PhD
Psychology | Brain Health | Cognitive Performance
This article provides educational commentary, not individualized medical advice. Psychiatric medication decisions, including changes or discontinuation, require individualized consideration of risks and benefits with an appropriately qualified prescriber.