The invocation of exceptionalism can be beneficial, but it can also exact a cost. Employed nationalistically – for example, ‘American exceptionalism’ – it can inspire the citizenry or rally a mob. ‘HIV exceptionalism’ protects vulnerable patients but may compromise public health. Whenever psychiatry asserts special status relative to other medical disciplines, ‘psychiatric exceptionalism’ is implied. Supplemental confidentiality protections, the care of ‘clients’ rather than patients, the psychopharmacologist designation, and other practices emphasise the other-ness of psychiatry. Cumulatively, these attempts to be or to appear to be ‘exceptional’ have the unintended effect of reinforcing the image of psychiatrists and their patients as exceptions.