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

Paul Linde (Author)

Book Description

Publication Date: January 7, 2010

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.

Editorial Reviews

From 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.)
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From Booklist

From Linde’s perspective, a psychiatric emergency room doctor is more like a cowboy than a “navel-gazing psychiatrist.” Judging from the likes of some of the folks he encounters on the job, it indeed appears that such metaphors for psych ER work as wrangling, hog-tying, bull-riding, and herding are more appropriate than, say, meditating. There is also the loneliness factor. While Linde acknowledges the expertise of the San Francisco General Hospital psych ER team he works with, in the end, it is his call whether a patient be admitted for additional assessment and/or treatment. It is his decision, that is, with consideration for the latest laws governing involuntary confinement and whether or not the patient’s insurer will cover treatment. It is also his call whether to treat patients according to the current psychiatric trend or buck the system. Taking into consideration everything from his phlegmatic attitude toward his patients’ antics to the ever-evolving restrictions, political and financial, hamstringing his ability to do his job, Linde seems well suited to life as a lonesome cowboy. --Donna Chavez

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Product Details

• Hardcover: 280 pages
• Publisher: University of California Press; 1 edition (January 7, 2010)
• Language: English
• ISBN-10: 0520249844
• ISBN-13: 978-0520249844
• Product Dimensions: 8.3 x 5.9 x 1.1 inches
• Shipping Weight: 1 pounds (View shipping rates and policies)
• Average Customer Review: 4.5 out of 5 stars  See all reviews (20 customer reviews)
• Amazon Best Sellers Rank: #681,720 in Books (See Top 100 in Books)

More About the Author

Paul R. Linde, M.D. is a Clinical Professor of Psychiatry in the University of California, San Francisco School of Medicine. He's worked as a clinician/teacher in the Psychiatric Emergency Service at San Francisco General Hospital since 1992 and in several other high-intensity psychiatric settings over the years. A writer of medical/psychiatric nonfiction, his second book, Danger to Self: On the Front Line with an ER Psychiatrist, was released by the University of California Press in September 2009. He has also written for JAMA, the San Francisco Chronicle, San Jose Mercury News, and DoubleTake magazine. Dr. Linde also created, produced, and hosted a weekly health program on KALW-FM in San Francisco from 2002 to 2004. He lives in the Bay Area with his wife, two sons, and a rambunctious one-eyed dog. For more details, check out paullinde.com.

Customer Reviews

Most Helpful Customer Reviews

19 of 20 people found the following review helpful:

5.0 out of 5 stars Powerful narrative of a San Francisco Emergency Psychiatrist, November 3, 2009

By 

J. Schultz (Seattle, WA) - See all my reviews
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This review is from: Danger to Self: On the Front Line with an ER Psychiatrist (Hardcover)

Dr. Paul Linde, a psychiatrist at SF General Hospital, provides a fascinating glimpse into the mental health issues, patients, and practitioners of an urban psychiatric emergency room in DANGER TO SELF. Loaded with interesting medical information, Linde's first person narrative is presented as a series of stories that are highly readable and convey the various roles asked of psych emergency doctors and nurses (e.g., jailor, jury, or clairvoyant). Written for the educated lay reader, the book not only gives a sense of the atmosphere and problems encountered in psych emergency, but also provides a context in which to understand the complex decisions and value judgments that acute care psychiatrists must make. Dr. Linde has a good grasp of the historical and legal contexts in which decisions need to be made, e.g., how does one protect an individual's civil liberties while maintaining the public's need for safety? When is it morally justifiable to revoke a person's right to freedom? Analysis of these issues and others offer much for the reader to think about further.

Dr. Linde writes in the Preface that his intention is to humanize psychiatrists, other mental health professionals, patients, and their loved ones and that it is okay at times to laugh, to swear, to self-reveal, and to cry with patients. Linde's stories convey the humanity and compassion of the doctor-patient relationship in a truly engaging and engrossing manner. In my opinion, Dr. Linde has clearly succeeded.

19 of 23 people found the following review helpful:

5.0 out of 5 stars He nailed it!, November 11, 2009

By 

Jo Ellen Brainin Rodriguez (San Francisco) - See all my reviews
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This review is from: Danger to Self: On the Front Line with an ER Psychiatrist (Hardcover)

As a fellow traveler in the trenches of public sector emergency psychiatric services, I found Dr. Linde's book very evocative. He captured the emotional tone well with its mix of sadness, humor, horror and ambiguity. I appreciated his exploration of the training issues and deeper policy issues that underlie the complexities of psychiatric care.
The book is a good companion to Fuller Torrey's new book about the unintended consequences of laws designed to protect the rights of the mentally ill. I recommend this book highly for those who work with the severely and persistently mentally ill. For those who love the caretakers and wonder what they do all day, this book sheds light on their day to day experience.

5 of 5 people found the following review helpful:

5.0 out of 5 stars This book is in the top five books I've read in the past year., June 7, 2010

By 

Elena Rakhaeva (Washington, DC) - See all my reviews
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This review is from: Danger to Self: On the Front Line with an ER Psychiatrist (Hardcover)

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 they are in a human circus; he tells their stories in a calm and compassionate manner with respect for who they are and where they come from. Those who look for serious discussions of particular disorders or medications, or health care system will also be disappointed. This is not a textbook or a diagnostic manual.
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.