“Hypercritical Allostatic Load,” by Shay Seaborne, CPTSD. Watercolors, ink, psychiatric hospital pencil. 12×9″
Six years ago, I was dying from hypercritical allostatic load: far too much stress with far too insufficient support for far too long. My body was shutting down. I spent much of my 60th year in bed. The strain had been building for decades through developmental trauma, repeated adversity, loss, chronic stress, and, most absurdly, a growing accumulation of medical harm in response to my requests for help.
Instead of finding real help, I encountered certainty, over and over. Practitioners were certain that they knew better than my lived experience in this body. They could not believe what I said.
The more my condition deteriorated due to lack of appropriat care, the more confidence I encountered. That pattern revealed something important about healthcare. Certainty blindness occurs when a practitioner is more attached to their explanation than they are interested in the information in front of them.
Once that happens, contradictory evidence often stops registering. The patient says they are getting worse. The practitioner says they are not. The patient reports increasing functional impairment.The practitioner focuses on reassurance. The patient keeps returning because the problem is not resolved. The practitioner sees repeated help-seeking as evidence that the original conclusion was correct.
From a Relational Neuroscience perspective, human beings make sense of reality together. We rely on one another to help us understand what we are experiencing. Healthcare relationships carry particular weight because practitioners hold specialized knowledge and institutional authority. When a practitioner repeatedly dismisses a patient’s observations, they give their own interpretation more weight than the patient’s lived experience.
In practice, certainty blindness often looks like reassurance. It sounds kind, calming, and reasonable. But reassurance based on an inaccurate assessment is not protective.It delays investigation, treatment, appropriate support, and shifts attention away from what is actually happening.
In my case, nobody needed to know exactly what was wrong. They simply needed to recognize that something serious was happening. “I don’t know” would have been far more useful than misplaced confidence. Curiosity would have been more useful than certainty. A willingness to observe what was unfolding would have been more helpful than explaining it away.
One of the most damaging assumptions in healthcare is that access equals care. It does not. I had access, appointments, practitioners, and their opinions. I did not have appropriate care. Care that listened.
Many people assume that if someone is suffering for years, they must not have sought help. Often the opposite is true. They sought help repeatedly, but were trapped in systems where certainty was valued more highly than observation.
When people repeatedly bring forward accurate observations about themselves, and those are dismissed, important information is overlooked. Opportunities for intervention are lost. Trust in healthcare relationships is ruptured. The practitioner leaves the appointment believing they have reassured the patient, while the patient leaves carrying the consequences of being wrongfully reassured: feeling unseen, unheard, disbelieved, and unhelped.
Effective care requires a practitioner to hold space for the unknown rather than closing it with premature answers. The responsibility remains with them to value observation over their own internal narrative. By choosing curiosity over conviction, they create the necessary room to truly hear what a patient is communicating, ensuring that clinical certainty does not override clinical evidence.
