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.
Preface. Nowhere to Hide
1. The ER Doc: Who's Calling the Shots?
2. The Rookie: Bruno's Man Down
3. The Scrambler: How to Prevent a Murder
4. The Psychodynamo: Learning to Listen with a Professional Ear
5. The Jailer: If You Want to Go, You Have to Stay
6. The Jury: Playing the Suicide Card
7. The Clairvoyant: Whose Life Is It Anyway?
8. The Speed Cop: Talking to Tina
9. The Witness: Trauma Underlies the Pain
10. The Judge: Playing God from a Psychiatric Standpoint
Epilogue. Straight from the Heart
Paul R. Linde, MD, is Clinical Professor of Psychiatry in the School of Medicine, University of California, San Francisco and the author of Of Spirits and Madness: An American Psychiatrist in Africa.
“Linde's Danger to Self is a warm, candid and appealing account of being an emergency room psychiatrist. Linde captures the non-conformist, hard-boiled style of the psychiatrists who work in this setting.”—Tanya Luhrmann, author of Of Two Minds
"Linde illustrates academic points with his personal experiences quite deftly. He comes across as a warm-hearted, thoughtful, dedicated physician doing a difficult job as best he can. His book offers an authentic behind-the-scenes look at how a psychiatrist thinks and practices." —Frank Huyler, author of The Blood of Strangers
“In this provocative first-person account, Danger to Self, psychiatrist Paul Linde takes us to the troubling front lines of America's mental healthcare crisis. With one in three people experiencing some form of mental illness in their lifetimes, this is a story that needs to be told. Linde waves a red flag that can't be ignored.”—Kemble Scott, author of SoMa and The Sower
“Danger to Self is an excellent account of treating acute mental illness. Dr Linde presents powerful stories of disturbed minds and circumstances, of lives in upheaval due to psychosis, addictions, and despair. It is also the story of the story of a psychiatrist who tends to those who are ill enough to warrant treatment in a psychiatric emergency room. This is a well-written book, compassionate, and well worth the reading.”—Kay Redfield Jamison, author of An Unquiet Mind
2010 Media Award, Northern California Psychiatric Society