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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.
Acknowledgments 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 Notes References
This book is in the top five books I've read in the past year.
This is not quite an entertainment, so those who look for "hot stories about crazy people" will probably be a little disappointed. The author does not display people in distress like the human circus; he tells their stories in a calm and compassionate manner with respect for who they are and where they come from.
Psych ER is a highly stressful environment with insanity pushed to its limits; patients represent a danger to self, or others, and to keep oneself not just calm and professional but respectful and sensitive to others' pain is a gift.
I like how Dr. Linde places main focus on his patients and the hospital/city environment, not himself; this allows seeing unfolding dramatic stories in a context of a bigger picture of current medical/urban reality. At the same time there is a strong author's presence in this book, and his personality gradually reveals itself through little phrases, observations, and humor.
I enjoyed every story and I highly recommend this book to those who are in the process of becoming mental health professionals or just curious what it is like to be a psych doctor in ER.
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Posted September 15, 2010
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