Synopsis

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.

Publishers Weekly

Linde (Of Spirits and Madness), clinical professor of psychiatry at the University of California–San Francisco medical school, performs a remarkably successful balancing act by presenting both the theory and practice of emergency room psychiatry in a compelling manner. He personalizes his cases and demonstrates how essential the human dimension is in high-quality care. Using 10 fascinating case studies from his 17-year career—with patients manifesting symptoms from suicidal behavior to catatonia—Linde discusses the medical, legal, philosophical and ethical implications of treatment options. He brings the reader along as he is forced to make almost immediate diagnoses and determine courses of treatment, including incarceration, that have the potential to shape (or end) these patients' lives. It becomes abundantly clear that there are rarely simple, straightforward answers. Linde quotes a professional bromide: “[t]he only thing that two psychiatrists can agree on is that a third one is wrong.” He's a talented writer and a compassionate doctor who understands what works best for him and his patients: “while my head works pretty well, my real strength as a physician comes from the heart.” (Jan.)

Biography

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.