Loshi Rajen

Historically, followers have been positioned as subordinate actors, defined more by compliance than by contribution. In contrast, leadership roles are associated with an assumption of power, which may be formal, positional, and at times authoritative. This dichotomy is misleading. Many individuals in formal leadership roles experience constraints in their ability to effect change, as authority alone does not reliably translate into influence.

While shadowing a senior colleague during Mental Health Act assessments in the U.K. a few months ago, I noticed something small but instructive. In his documentation for two different patients we had seen together, he referred to me as Dr followed by two different versions of what he assumed to be my surname. Later that same day, while introducing me to colleagues who were joining us, he hesitated.

One of the hardest questions in intellectual disability psychiatry that I have found myself grappling with over the past year as a registrar in the subspecialty is surprisingly simple: Is this person in pain? Most people assume pain announces itself clearly. A broken bone hurts. A toothache hurts. An infection hurts. The body sounds an alarm and we respond. In practice, as I have encountered time and again, it is rarely that straightforward.