One of the gratifying things about inpatient psychiatry is seeing improvements in mood, more or less in real time. We’ve had patients who came in on the verge of suicide, who over the course of their stay seem like completely different people; smiling, laughing, hopeful.
The sad part is sometimes when patients come in for their discharge interview I can’t help but feel like there’s something hidden behind an almost-too bright smile and cheery mood.
It’s not that I don’t believe that they are doing better or that I don’t think that they are capable of getting “better.” I just know that if was somewhere I didn’t want to be for whatever reason, and I knew putting on a smile would help get me out, I could easily fake it as long as I needed to (speaking from experience). Hell, I’d put on a whole damn show.
My concern is not simply whether or not they are faking it, but more so the implications if that’s true. It means we failed. It means we were no better than all the others that came before proclaiming that we care and that we want to help, but we didn’t do enough, and they will think twice next time about coming to us for help.
This is all existing in my overthinking brain though. I’m somewhat assured by the fact that patients seem to do well after they leave. And many patients do voluntarily return if things take a turn for the worse. But is also in the setting of recognizing that our mental health systems are far from perfect and people deserve better than what we are currently offering.