Recidivism in psychiatric patients

It has been a running joke with one of my residents, my optimism when it comes to the chances that my patients will actually make meaningful changes in their lives. Out of curiosity, and as a sort of exercise, we sat down together and reviewed the charts of my patients from earlier in the month. My meth addict patient? Missed his follow-up appointments. My alcoholic patients? They all missed their appointments. My borderline patient with anger issues and family problems? "Oh, look," my resident chuckled, "He made his optometry appointment but missed his psychiatrist and family therapy appointments! That's interesting..."

She wasn't so much rubbing it in my face as making her point that, as a psychiatrist, you can't expect your patients to change any more than they are ready to change. It's easy to get discouraged and jaded, she said, the more of yourself you invest in their recovery. Her eyes widened for a flash, a microexpression. I think she got worried that I might judge her as jaded and cynical. But I understood what she meant. It was natural for me to want to single-handedly fix my patients' self-destructive behaviors, but the game was already lost the moment my motivation exceeded my patients' motivation for change.