We will decide your narrative
The medical history of suicidal psychiatric patients can easily become their life story. The narrative of the illness becomes the patient's story. This is despite the fact that healthcare documents are largely composed of contextless, momentary observations of limited value. The observations describe and interpret behaviour with considerable uncertainty, little precision and far-reaching consequences. Psychiatrists and psychologists presumably have the key that can give meaning to the material. However, the life stories are also read by others.
We find the momentary observations in the discharge reports repeated in the health authority's reports, as a clueless amplification of meaning and relevance in the authorities' assessment of what constitutes proper treatment.
At some point in the supervisory authority's investigations into suicide in psychiatric patients, the treatment, as recommended in regulations and procedures, will match the description of the actual events as documented in records and discharge reports. Is it possible to get an accurate picture of what happened when the inspectorate assesses risk understanding and treatment? Or does the health data allow for selective use that renders the investigation irrelevant and irresponsible? And perhaps worse: the discharge reports, and how they are written, can cause serious health problems for the patients who read them.
When a key part of the description involves observations such as 'nicely dressed', 'lacks facial expression' and 'speaks in coherent sentences', it is easy to question the point of this, but we can also observe the negative consequences. We ask: Have the documents contributed to the patient's improvement? And: Is the story being told true?
I believe the answer to both of these questions is no. Suicidal patients have a fragile self-image. The hospital's descriptions are interpreted and understood from this perspective. The vast majority of people who take their own life did not want to die. They wanted to live. They were fighting a battle where the enemy was themselves and the voices telling them they were ugly, worthless and should die. They die alone, lonely, desperate and afraid. And when they are gone, it is as if they never lived. The voices, the illness and the loneliness merge with the narrative of the system leading them to their inevitable conclusion – that suicide is the only option.