That moment of misdirection, described by Dr. Danilo Rojas-Velasquez of Harvard Medical School and Beth Israel Deaconess Medical Center in a new viewpoint article published in Academic Psychiatry, sits at the heart of an argument that is gaining urgency across academic medicine: the language clinicians write into charts is not a neutral record but a durable force that shapes how every subsequent clinician perceives a patient. Psychiatry, a chart-heavy specialty in which practitioners learn to scan prior notes for buzzwords that key early hypotheses, is particularly exposed. Words travel with patients across years of records, and the language chosen by one team determines how the next team imagines the person in the bed.

Clinical medicine has already made a deliberate effort to soften the edges of its vocabulary. Undomiciled has largely replaced homeless, non-adherent has supplanted non-compliant, and declined is preferred to refused. These substitutions reflect a genuine ethical awareness that stigmatizing descriptors can follow patients for decades. But Rojas-Velasquez argues that such lexical swaps can function as a kind of hygiene that leaves the underlying clinical gaze unchanged. A patient called non-adherent by a frustrated team is not necessarily better understood than one called non-compliant; the person is simply described in the currently sanctioned vocabulary. The deeper issue is not which words are approved but what those words do once they are placed in a chart and begin to circulate.

The empirical evidence behind this concern is substantial. A growing body of research documents that stigmatizing language in the medical record measurably alters downstream clinical decisions, including pain management and the intensity of diagnostic workups. Studies have found that descriptors such as pleasant and cooperative are applied unevenly across patient race, meaning that the chart itself can become a vector for the transmission of bias. Physician use of stigmatizing language in patient records has been documented systematically in large-scale analyses, and researchers have shown that negative framing in one note propagates into the impressions formed by later readers. Yet documentation is still often treated as a matter of mechanics: billing compliance, problem-list hygiene, and the architecture of the assessment and plan. The ethics of clinical language, what a clinician is actually doing to a patient when writing about them, has remained a hidden curriculum, absorbed by osmosis from whichever notes a trainee happens to read.

Into this landscape, ambient scribes and large language model-assisted documentation are arriving faster than the educational infrastructure can adapt. Randomized trials of ambient AI scribes in clinical practice are already underway, and health systems are deploying the tools at scale. The technical mechanism of concern is subtle but consequential: AI tools inherit and polish the linguistic conventions of their training data, which means that stigmatizing patterns already present in charts are being laundered into outputs that feel more authoritative precisely because they are fluent. A trainee who might once have written that a patient seems frustrated may now sign a note describing him as hostile and uncooperative simply because that is what the model produced. Fluency, in this context, is not accuracy; it is a cosmetic upgrade applied to inherited bias.

There is also an educational cost. Historically, the note has been the place where clinical formulation happens. Writing was thinking, and the attending’s question of why a trainee described a patient in a particular way was a teaching moment built directly into the workflow. When the note arrives pre-formed by an algorithm, that moment is structurally removed unless educators deliberately rebuild it. The formulation step, in which a clinician weighs observations, considers alternative explanations, and commits to a reasoned characterization of the patient, is being quietly absorbed by the model. What remains for the trainee is verification, which is a fundamentally different and far less formative cognitive task.

In response, the article proposes three practical steps for teaching note writing in the age of AI. The first is to teach note-reading before note-writing. On a rotation, a resident might review prior documentation, name the impression those notes created, and then compare that impression with what actually emerges at the bedside. The point is not to grade the prior note or its author but to make the chart’s authorial power visible before the resident adds to it. This exercise converts an invisible influence into an object of explicit study, allowing trainees to feel firsthand how a one-line summary can pre-load an entire clinical encounter with assumptions.

The second step is to build a next-reader pause into supervision. Before signing a note, the trainee considers how it would read to a covering clinician at three in the morning, to the patient with portal access, and to a family member reviewing the chart. Open Notes initiatives and patient-facing documentation have already shifted the audience for clinical writing; patients can now read the words written about them, and imagining these readers helps residents notice attributions and tones of voice that would otherwise pass unexamined. Qualitative work on patient-centered documentation in the era of open notes suggests that this kind of deliberate audience-awareness changes how clinicians draft, encouraging precision and fairness over shorthand judgment.

The third step treats the editing of AI-drafted notes as genuine clinical work rather than clerical review. If formulation is being absorbed by the model, the trainee’s task is not merely to check grammar or fill gaps but to interrogate what the draft has already decided: where observations have hardened into character judgments, where hedge words have drifted toward unwarranted certainty, and where descriptors would not survive the next-reader test. The article suggests a weekly note rounds, in which a team reviews and revises an anonymized AI-drafted note together, turning a hidden judgment back into a shared teaching moment. In this arrangement, the AI draft becomes a specimen to be dissected rather than a product to be signed, restoring the pedagogical function that automation threatened to erase.

The chart remains one of the few places in medicine where a patient is constructed in their absence, by people with power over them, in language they have historically been unable to see. Open Notes is changing the last part of that sentence, and ambient AI is changing the second, but the construction itself endures, and arguably matters more now than it did when notes lived in locked basements. Consultation-liaison psychiatrists, who live in other clinicians’ notes before they ever meet their patients, are unusually positioned to notice this dynamic. They watch language do its quiet work, and they write notes that will in turn shape how the next team thinks. Whether the current generation of trainees inherits a thoughtful relationship to that responsibility, or simply a more polished vocabulary applied at greater speed, will depend in large part on how medical educators decide to teach it. The stakes are not stylistic. They concern who patients become on paper before anyone meets them in person, and whether the accelerating machinery of AI-assisted documentation amplifies clinical understanding or merely automates its failures.

Subject of Research: Teaching ethical clinical documentation and note-writing skills to psychiatry trainees in the era of AI-assisted medical records

Article Title: Teaching Note Writing in the Age of AI: Three Practical Steps

Article References: Rojas-Velasquez, D. (2026). Teaching Note Writing in the Age of AI: Three Practical Steps. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02434-5

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02434-5

Keywords: clinical documentation, artificial intelligence, psychiatry education, stigmatizing language, medical records, ambient AI scribes, large language models, Open Notes, clinical formulation, medical bias, consultation-liaison psychiatry, graduate medical education

The concern emerges against a backdrop of rapid institutional response to generative AI. As large language models have become widely available, many journals, universities, and professional bodies have adopted policies that limit or restrict the use of AI in academic writing. Enforcement of these policies has leaned heavily on AI detection software, tools that attempt to distinguish machine-generated prose from human writing by analyzing stylistic patterns, vocabulary choices, and overall cadence. The problem, as Smith and Aggarwal emphasize, is that these tools are far from infallible. Citing recent research, they note that even automated detectors do not achieve perfect accuracy, and that human readers perform considerably worse. One study found that people cannot identify AI-generated writing any more reliably than random chance would allow.

Despite these limitations, anxiety about being accused of using AI is demonstrably shaping how authors write. The em dash has been singled out in public discourse, including commentary in major newspapers, as a marker of perceived overuse by AI tools. Yet the authors point out that peer-reviewed studies establishing a genuine association between the punctuation mark and machine generation are lacking. The association is largely a matter of perception, amplified by social media conversation and anecdote rather than systematic evidence. Still, perception can be powerful. Because the em dash may now carry a negative connotation, authors who wish to avoid evoking skepticism from reviewers and editors may simply stop using it.

The pressure is not hypothetical. In preparing a prior manuscript, one of the authors was advised by a mentor that the use of em dashes might be interpreted by reviewers as a sign of AI involvement. Both authors report hearing similar accounts from colleagues across academic medicine. These anecdotes suggest that a quiet recalibration of writing style is already underway, driven not by journal policy or formal guidance but by fear of suspicion. The authors argue that trainees and early-career academics, who are still developing their scholarly voices, may be particularly vulnerable to these pressures, internalizing the idea that certain stylistic choices are risky before they have had the chance to make those choices their own.

What is at stake, the correspondence contends, extends well beyond a preference for one punctuation mark over another. Writing, like other forms of art, is a medium through which individuals express personality, share perspective, and communicate thought. Stylistic signatures, including rhythm, cadence, and punctuation habits, are part of what makes an author’s voice recognizable. By unnecessarily restricting these elements, the academic community risks constricting what scholars are able to say and how they are able to connect with readers. The authors suggest this may be particularly damaging in fields such as psychiatry, where narrative skill and clarity of expression are not decorative extras but essential professional tools, central to both clinical communication and scholarship.

The technical reality of AI detection undercuts the logic of policing individual stylistic features. As Smith and Aggarwal observe, even automated detection software does not rely on any single tell in isolation. Instead, such systems perform a holistic analysis of a piece of writing, weighing overall style, paragraph length, grammatical choices, and vocabulary together before rendering a judgment. If the most sophisticated detectors require whole-text analysis to reach conclusions of imperfect reliability, then treating a lone punctuation mark as evidence of machine authorship is analytically indefensible. Overemphasis on a single element, such as punctuation considered in isolation, raises the very real potential for false accusations against human authors whose only offense is a fondness for the em dash.

The authors’ proposed alternative is straightforward: rather than asking authors to change how they write, the field should emphasize and demand transparency about AI use. This means clear authorship guidelines and explicit journal policies governing the use of generative AI, together with education for scholars on the importance of disclosure. Transparency, in this framing, addresses the actual problem, which is undisclosed machine assistance, rather than punishing stylistic expression that happens to overlap with the output of language models. The approach aligns with emerging guidance in medical education publishing, including recent international guidance on when and how to disclose AI use in academic publishing.

At the same time, the correspondence does not dismiss the need for safeguards. Smith and Aggarwal acknowledge that protections surrounding AI use are vitally necessary to prevent the field from becoming over-reliant on technology, with the risks to originality, accountability, and scientific integrity that such reliance would entail. Their argument is one of proportion: safeguards should target disclosure and integrity, not the erosion of individual voice. The distinction matters because style-based policing is both ineffective, given the weakness of the evidence linking any single feature to AI, and corrosive, given that it teaches a generation of writers to flatten their prose into something inoffensive and anonymous.

The em dash controversy is a small episode with outsized symbolic weight. It captures a moment in which institutions, reviewers, and writers themselves are groping toward norms for a technology that arrived faster than the rules governing it. The message from these psychiatry educators is a caution against premature judgment: with imperfect detection software, even less accurate human judgment, and only a weak and largely anecdotal association between a punctuation mark and machine text, the field should not allow a perceived association to change how people write. How we communicate, they argue, is too important to be dictated by suspicion of a dash.

Subject of Research: The impact of perceived AI-associated writing styles on academic authorship and publishing

Article Title: The Em Dash—Should We Allow AI to Change Our Writing Styles?

Article References: Smith, A. C., & Aggarwal, R. (2026). The Em Dash—Should We Allow AI to Change Our Writing Styles?. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02435-4

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02435-4

Keywords: em dash, artificial intelligence, academic writing, AI detection, writing style, academic publishing, authorship, transparency, psychiatry education, generative AI, scholarly voice, peer review

The proposal builds on one of the most consistent findings in suicidology, often called the gender paradox of suicide. Across many countries, women report higher rates of suicidal ideation and make more suicide attempts than men, yet men account for the majority of suicide deaths. The traditional explanations for this discrepancy focus on method lethality, impulsivity, substance use, and differences in help-seeking behavior. Men more frequently use highly lethal means, while women’s attempts are more often survived, leaving more opportunities for intervention but also, the authors suggest, more opportunities for dismissal. These epidemiological accounts remain important, but Courtet and Olié contend that they leave a crucial dimension of prevention unaddressed: the way suicidal suffering is interpreted, validated, or discounted in clinical and social settings.

The new concept shifts attention from the prevalence of suicidal behavior to the interpretation of distress. Women, the authors note, frequently communicate emotional suffering, suicidal ideation, and relational despair. Yet these very expressions may contribute to their pain being perceived as exaggerated, relationally motivated, or less clinically serious. On this account, women may face elevated suicide risk not despite expressing distress, but partly because the expression itself invites disbelief. At comparable levels of distress, women can encounter a form of epistemic disqualification in which their own account of suffering loses clinical authority, a dynamic with measurable consequences for assessment and triage.

Courtet and Olié ground the concept in a detailed reading of La Vérité. The film follows Dominique Marceau, played by Bardot, who is on trial after the death of her lover. Throughout the narrative, Dominique repeatedly expresses distress and engages in suicidal behaviors that are persistently minimized or dismissed by those around her. Her words are heard not as testimony but as strategy. Her emotional reactions are attributed to immaturity. Even her silences become suspect. Crucially, the repeated suicidal behaviors do not reinforce the seriousness of her condition; instead, they progressively undermine her credibility, so that prior attempts become reasons for disbelief rather than warning signals. Neither her family, nor her partner, nor the judicial system fully recognizes her distress as serious or dangerous.

The authors stress that this dynamic cannot be separated from the star who embodies the character. By 1960, Bardot had become a cultural symbol associated with desire, freedom, emotionality, provocation, and presumed frivolity. This extradiegetic identity profoundly shapes how Dominique’s suffering is interpreted on screen: what might be recognized as despair in another woman is repeatedly recast as performance, seduction, exaggeration, or manipulation. Dominique is not ignored because she remains silent; she is ignored because she expresses too much. Her suffering becomes illegible precisely because it is visible. A woman culturally associated with beauty, sensuality, and emotional excess becomes structurally difficult to imagine as a bearer of authentic psychic pain. The film thereby exposes a broader social mechanism in which femininity itself may undermine credibility, with a woman’s body, image, or emotional expressiveness preceding her words and shaping interpretation before she is even heard.

The mechanism has a theoretical footing in contemporary suicidology. Edwin Shneidman conceptualized psychache as an intolerable subjective experience characterized by hopelessness, shame, humiliation, and loss of self-coherence. Subsequent research has shown that psychic pain becomes particularly dangerous when it is experienced as unshareable or invalidated. Case-control studies of medically serious suicide attempts have linked mental pain and communication difficulties to the most damaging outcomes, suggesting that failures of validation are not merely an interpersonal inconvenience but a clinically relevant risk factor. When disclosures of suffering do not lead to understanding, support, or adequate intervention, patients may experience increasing isolation, hopelessness, and entrapment. Suicide then appears not as an impulsive act, but as the endpoint of pain rendered unbearable because it has become psychologically and socially unshareable.

The authors are careful to specify that the paradox does not require conscious bias. Clinicians, relatives, and institutions need not deliberately dismiss women’s suffering. Instead, emotional expression that is repeated, relationally mediated, or perceived as excessive may gradually lose its alarm value. Habituation sets in: what once signaled escalation comes to be read as chronic emotionality. In such contexts, repeated verbalization of suicidal thoughts paradoxically contributes to the normalization of distress rather than the mobilization of care. This framing converts a moral accusation into a systems-level description of how recognition fails, which makes the concept trainable rather than merely accusatory.

The gendered pattern of interpretation is well documented in the literature. Women’s suicidal expressions are more likely to be understood through interpersonal or emotional frameworks rather than as indicators of high acute risk. Attempts by women are frequently characterized as gestures, cries for help, or manipulative behaviors, whereas suicidal acts by men are more readily perceived as serious and definitive. These asymmetries in interpretation can shape clinical decision-making at every stage, from emergency triage to inpatient admission and follow-up intensity. If clinicians systematically assign lower risk to women whose distress is expressed in emotional or relational terms, prevention efforts are calibrated to the wrong signal, and the patients most vocal about their pain may be those least protected.

The clinical implications, the authors argue, are substantial. Suicide risk emerges not only from the intensity of psychological pain but also from failures in recognition and emotional validation. Current approaches increasingly emphasize therapeutic assessment, collaborative formulation, and personalized intervention, and suicidal ideation and associated risk factors, including psychic pain, must be addressed through evidence-based pharmacological, psychotherapeutic, and psychosocial strategies. But such personalization remains insufficient if it rests on biased interpretations of emotional suffering. Ensuring that women’s expressions of psychological pain are granted full clinical credibility is, in the authors’ words, not only an ethical issue but a core component of suicide prevention.

The article also carries a pedagogical proposal. La Vérité, the authors suggest, can serve as a valuable teaching tool for psychiatry trainees because it dramatizes how gendered assumptions shape the interpretation of suicidal suffering, reminding future clinicians that risk may be underestimated not despite emotional expression but because of it. Psychiatric educators, they write, could develop the pedagogy of using the film in training and examine cultural differences in the ways women express distress and emotional turmoil. In this sense, the Gendered Credibility Paradox extends the classical gender paradox of suicide by shifting attention from suicidal behavior itself to the social and clinical processes through which suffering acquires, or loses, credibility. For a specialty trained to elicit suicidal ideation and to treat a previous attempt as a marker of risk, the lesson is uncomfortable but precise: listening is itself an interpretive act, and credibility is not granted evenly across patients.

The Montpellier authors situate their argument within a broader line of inquiry into how gender shapes the expression of psychological suffering. One of the co-authors has previously examined the suicides of women artists, arguing that the cultural framing of female creativity and emotionality influences both how these women communicate distress and how their deaths are subsequently understood. That earlier work anticipated the central move of the new viewpoint: treating interpretation, rather than behavior alone, as an object of scientific study in its own right.

The concept also invites reflection on the institutional settings in which credibility judgments are made. In La Vérité, the courtroom provides the dramatic frame, and this is not incidental. Legal and medical settings share a reliance on testimony, and both depend on assessors deciding whether an account of inner states is trustworthy. When a speaker’s prior disclosures have been catalogued as repeated, dramatic, or relationally motivated, each new disclosure is evaluated against that record, creating a self-reinforcing loop in which the evidence of seriousness is converted into evidence of unreliability.

The film’s release date gives the teaching case additional resonance. Clouzot’s drama appeared at the close of a decade in which Bardot’s public image had been constructed largely through her association with youthful spontaneity and emotional immediacy. The authors’ point is not that the film was intended as a critique of psychiatric practice, but that a fictional narrative can render visible a pattern of misreading that is difficult to observe in real consultations, where the same interpretive habits operate silently and without the benefit of narrative hindsight.

For educators, the proposal aligns with a wider movement in medical training toward the use of narrative and cinematic materials to teach clinical reasoning. Such materials allow trainees to observe the consequences of interpretive choices from an external vantage point, then carry that awareness back into direct patient contact. The authors’ framing suggests that the goal of such exercises is not sensitivity training in a general sense, but a specific corrective: teaching learners to treat repeated expressions of distress as accumulating evidence of danger rather than as noise that discounts the signal.

Subject of Research: A proposed Gendered Credibility Paradox of Suicide in which women's expressions of psychological pain reduce the credibility granted to their suffering and contribute to underestimated suicide risk, illustrated through the film La Vérité.

Article Title: The Gendered Credibility Paradox of Suicide: A Teaching Case from Brigitte Bardot’s La Vérité

Article References: Courtet, P., & Olié, E. (2026). The Gendered Credibility Paradox of Suicide: A Teaching Case from Brigitte Bardot’s La Vérité. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02443-4

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02443-4

Keywords: suicide prevention, gender paradox, credibility bias, psychiatry education, Brigitte Bardot, La Vérité, psychache, suicidal ideation, risk assessment, mental pain, gender bias, Academic Psychiatry