Underground DSM

Bethany thinks it should be a whole book.  But really, I don't think I've got much more material.  However I have things to add today, and maybe I should just keep adding that into the larger post.

When someone says anything about honesty -
Can I be honest?
Not gonna lie
I'm just being honest
I truly think
I'm not sh---- you here
I really, really want
 - they usually mean something else.  Sometimes they mean candor, or bluntness.  Sometimes it's a feeling that they have no supporting evidence for. Sometimes they are saying true things, but leaving out other information that is important.  Sometimes it's just lying.  People who are speaking the truth generally don't reference "hey, did I mention that this is the truth?" They certainly don't make repeated references to how truthful and honest they are being.  In a side note, any political or religious organisation that uses the word "truth" in its name should be watched with the closest scrutiny.

This may be connected to the Biblical admonition of "Let your yea be yea and your nay be nay." (James)

Perhaps relatedly, many statements in mental health bureaucracies don't mean what their content would suggest, and I suspect there are parallels in your industry as well.  "I just want what's best for the patient," or "Look, we all want what's best for the patient here" usually means "Let's do what's best for my agency," or even, horribly, "we don't want to put in much effort to fix this and you're stuck with him, so we don't much mind if the patient is not being served."

Oh, oh, that reminds me.  When the hospital is discharging a patient over the objections of the family*- and this is often a risky proposition that we are wincing at and crossing our fingers over - I breathe a sigh of relief when someone shouts into my phone "If you discharge him today, I guarantee you he will be dead before midnight."  Whew.  So this is just a family that postures in overdramatic fashion, and the patient is cut from the same cloth, so their cat-and-mouse about suicide is mere drama. Good to know. The few actual suicides usually take us more by surprise.

And speaking of suicide, remember that there is a suicide rate for people leaving banks, people leaving schools, people leaving work, and people leaving hotels. The suicide rate for people leaving psychiatric hospitals over the next 30 days is only marginally higher.  It's just that ours make the newspapers and people think we should have done...something.

*this happens all the time and often really does suck for the family, who are up against it and have legitimate gripes, and a hospital is at least a safe and treatment-oriented environment for their brother, daughter, whatever. It's brutal to have a mental illness, and sometimes it's brutal to even be close to it.