Danger to Self: On the Front Line with an ER Psychiatrist

Danger to Self: On the Front Line with an ER Psychiatrist

Danger to Self: On the Front Line with an ER Psychiatrist

Danger to Self: On the Front Line with an ER Psychiatrist


The psychiatric emergency room, a fast-paced combat zone with pressure to match, thrusts its medical providers into the outland of human experience where they must respond rapidly and decisively in spite of uncertainty and, very often, danger. In this lively first-person narrative, Paul R. Linde takes readers behind the scenes at an urban psychiatric emergency room, with all its chaos and pathos, where we witness mental health professionals doing their best to alleviate suffering and repair shattered lives. As he and his colleagues encounter patients who are hallucinating, drunk, catatonic, aggressive, suicidal, high on drugs, paranoid, and physically sick, Linde examines the many ethical, legal, moral, and medical issues that confront today's psychiatric providers. He describes a profession under siege from the outside--health insurance companies, the pharmaceutical industry, government regulators, and even "patients' rights" advocates--and from the inside--biomedical and academic psychiatrists who have forgotten to care for the patient and have instead become checklist-marking pill-peddlers. While lifting the veil on a crucial area of psychiatry that is as real as it gets, Danger to Self also injects a healthy dose of compassion into the practice of medicine and psychiatry.


A doctor, however, who would still interpret his own role mainly as
that of a technician would confess that he sees in his patient nothing
more than a machine, instead of seeing the human being behind the

Viktor Frankl, Man’s Search for Meaning

I love my job when I’m not there. I’m a doctor in the psych emergency room at San Francisco General Hospital (SFGH). One reason I work there is that when I’m not there, I’m not there. I have a decent shot at separating out my job’s trauma and drama from the rest of my life. But in my workplace, there’s nowhere to hide.

Our staff room, which provides a slight refuge, is dominated by a huge table, dozens of mailboxes and forms along one wall, a copier, a fax machine, shelves of books, a little sink (over which hangs the requisite “Your mother doesn’t work here” sign), a microwave, a tiny fridge, an illicit toaster, food and drink remnants, and the computer monitors on which we keep electronic medical records. Up to fifteen administrators, staff members, interns, residents, and students might be stuffed in this approximately ten-by-fourteen-foot place at any one time. the space is . . .

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