Suicide by Security Blanket, and Other Stories from the Child Psychiatric Emergency Service: What Happens to Children with Acute Mental Illness

Suicide by Security Blanket, and Other Stories from the Child Psychiatric Emergency Service: What Happens to Children with Acute Mental Illness

Suicide by Security Blanket, and Other Stories from the Child Psychiatric Emergency Service: What Happens to Children with Acute Mental Illness

Suicide by Security Blanket, and Other Stories from the Child Psychiatric Emergency Service: What Happens to Children with Acute Mental Illness

Synopsis

This book offers a unique glimpse into the startlingly complex world of acute children's psychiatry through 12 chapters, each inspired by the actual visit of a child in psychiatric crisis to one of the most well-known psychiatric emergency rooms in the nation.

Excerpt

For the last decade, I have been the director of the Child Psychiatry Emergency Service at Massachusetts General Hospital (MGH). Until very recently, when Dr. Donovan joined the team, I ran the service by myself. I took calls almost every night, heard about almost every child who came through the doors of our Acute Psychiatry Service (APS), and shepherded both the adult resident on-site in the emergency room and the consulting child and adolescent psychiatry resident through the thought process that would lead them to a diagnosis, a treatment plan, and, ultimately, a disposition. These residents, who are in many different stages of training, learn to become both messenger and ambassador; they are on the front line, evaluating the patient, calling me to retell the story, then returning to the patient and offering the treatment plan we have concocted together. My family has become accustomed to my beeper going off at odd hours; over the years that plaintive alarm has receded into the background noise of our household and become no more than a slightly annoying yet familiar interruption.

Although I sometimes find the residents’ presentations less than thorough, I never tire of hearing the stories. Psychiatric diagnosis and intervention depend primarily on the history or the story the patient tells. In the emergency room, one always starts with the question, “What makes today different from all other days?” That is, why did this child end up here today rather than yesterday, last week, or tomorrow? With that question and with all the other necessary questions that follow, no detail is insignificant. Trainees tease me about my interest in what they consider simply trivial matters, especially during what they think should be a rapid emergency room evaluation. What difference does it make if a family shows up during a school vacation week? Could it be that family members can only manage their bipolar child for a few days of constant togetherness before everyone runs out of energy and can no longer tolerate unpredictable hostility toward a younger sibling? Does it really matter if the 17-year-old boy who presents with new signs such as paranoia or auditory or visual hallucinations is a high school athlete? It matters . . .

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