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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.
277 pages, Hardcover
First published December 8, 2009
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3,375 people want to read
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Displaying 1 - 30 of 73 reviews
August 9, 2023
The good: The stories of the patients, mad, bad, high, low enough to want to commit suicide and all the other varieties of craziness that end them up in a psychiatric emergency room.
The indifferent: As so much of it is 'on the job', I am usually interested in the methods and practice of medical training. However, the author's training for this job was essentially talking. About himself. I didn't find this fascinating. There were discussions of patients' rights and the ethics of treatment which also weren't fascinating but quite interesting.
The bad: The author takes it on himself to represent his entire medical speciality and philosophises and pontificates on too many boring aspects related to his profession like insurance companies, Big Pharma and all the usual suspects.
I used to like Tolstoy and quickly learned (from reading Anna Karenina) to skip over the politics and peasants and philosophising. I wish I'd read this book like that too.
Rewritten entirely 8 Aug 2023 when I found the book and saw its pages had been eviscerated by termites (which we call 'common hen' I have no idea why) and it brought it all back to me.
The indifferent: As so much of it is 'on the job', I am usually interested in the methods and practice of medical training. However, the author's training for this job was essentially talking. About himself. I didn't find this fascinating. There were discussions of patients' rights and the ethics of treatment which also weren't fascinating but quite interesting.
The bad: The author takes it on himself to represent his entire medical speciality and philosophises and pontificates on too many boring aspects related to his profession like insurance companies, Big Pharma and all the usual suspects.
I used to like Tolstoy and quickly learned (from reading Anna Karenina) to skip over the politics and peasants and philosophising. I wish I'd read this book like that too.
Rewritten entirely 8 Aug 2023 when I found the book and saw its pages had been eviscerated by termites (which we call 'common hen' I have no idea why) and it brought it all back to me.
March 5, 2010
God, Dr. Linde is suuuuuuuch a hero! Working with the crazies! Who say and do crazy things! You're amazing! I have an idea: you should write a book about yourself! A masturbatory expose about the struggle of being a wealthy, talented, good-looking, all-knowing psychiatric genius! And, in your book, you should mock your patients! And don't forget to analyze your own personal emotional struggles in excruciating detail. And while you're at it, you should make yourself look like a fucking martyr for daring to go onto the "front lines" with these monsters. Gosh, Dr. Linde, can I have your autograph?
December 9, 2009
This was a page-turner. The author writes about his experiences as a psychiatrist, primarily as an emergency room psychiatrist at the county hospital.
I know the hospital; it’s in my city, and I’ve known people who have worked there, both at PES (psychiatric emergency services, basically an emergency room where care can be provided for up to twenty-four hours) and the inpatient psychiatric unit(s).
Linde writes in a very accessible manner and he’s very personable and honest about himself. This is as much a memoir as a book about psychiatric care.
He writes about a very wide range of different types of patients/situations-settings he’s encountered over the years. He does spend a lot of time on each person he’s worked with, even though he rarely does long term work with anyone, so not that many people are described. I appreciated the in depth coverage he gives to each person but I also wish more patients had been included. He says a lot was left on the cutting room floor and I wish some of that material had made it into the book.
I guess I already knew this, but he says it takes a certain type of person to enjoy working psychiatric emergency and I agree with him and, at least with the current clientele treated at PES, I know it’s not the best job site for me. However, I very much enjoyed reading this book.
To give a few examples of the variety of people who Linde has seen in psychiatric emergency situations: a potentially suicidal country jail inmate, a young woman on a medical floor who’s overdosed and may require a liver transplant if she’s declared sufficiently psychologically sound, homeless people who are brought into the psych ER, people who have attempted or threatened suicide, people who are psychotic, depressed, manic, substance abusers, sociopaths who present with various issues. What makes this book particularly fascinating is that the author describes his feelings and reactions in some detail.
I know the hospital; it’s in my city, and I’ve known people who have worked there, both at PES (psychiatric emergency services, basically an emergency room where care can be provided for up to twenty-four hours) and the inpatient psychiatric unit(s).
Linde writes in a very accessible manner and he’s very personable and honest about himself. This is as much a memoir as a book about psychiatric care.
He writes about a very wide range of different types of patients/situations-settings he’s encountered over the years. He does spend a lot of time on each person he’s worked with, even though he rarely does long term work with anyone, so not that many people are described. I appreciated the in depth coverage he gives to each person but I also wish more patients had been included. He says a lot was left on the cutting room floor and I wish some of that material had made it into the book.
I guess I already knew this, but he says it takes a certain type of person to enjoy working psychiatric emergency and I agree with him and, at least with the current clientele treated at PES, I know it’s not the best job site for me. However, I very much enjoyed reading this book.
To give a few examples of the variety of people who Linde has seen in psychiatric emergency situations: a potentially suicidal country jail inmate, a young woman on a medical floor who’s overdosed and may require a liver transplant if she’s declared sufficiently psychologically sound, homeless people who are brought into the psych ER, people who have attempted or threatened suicide, people who are psychotic, depressed, manic, substance abusers, sociopaths who present with various issues. What makes this book particularly fascinating is that the author describes his feelings and reactions in some detail.
May 16, 2011
A well-written book that aspires to contextualize the emergency room procedures for the mentally ill in the legal and social issues they also involve. The narrative voice is clear and for someone who hasn't thought about the non-medical issues surrounding mental illness, this would operate as a decent primer. The chapters on the homeless alcoholic who refuses inpatient care, and the petty drug-dealer eager to con his way into inpatient care are probably the best in terms of offering a realistic picture of the limits involved in creating a viable support network for the mentally ill.
Still, the book was unsatisfying. Anyone in social work, anyone who knows someone with a severe mental illness, will have thought through almost all of the issues Linde brings up -- and in more detail than he does. Oddly missing from the book are portraits of the schizophrenics and acute manic depressives whose flair-ups are the psychiatric emergency room's bread and butter. In fact, this book has nothing to say about the long-term reality of mental illness. Linde keeps saying he's a "cowboy" in the psychiatric world, and if this is true, cowboys have a pretty easy life. Keeping someone from killing themselves in the first 36 hours of a crisis is a cakewalk compared to the daily ins and outs of dealing with mental illness.
Still, the book was unsatisfying. Anyone in social work, anyone who knows someone with a severe mental illness, will have thought through almost all of the issues Linde brings up -- and in more detail than he does. Oddly missing from the book are portraits of the schizophrenics and acute manic depressives whose flair-ups are the psychiatric emergency room's bread and butter. In fact, this book has nothing to say about the long-term reality of mental illness. Linde keeps saying he's a "cowboy" in the psychiatric world, and if this is true, cowboys have a pretty easy life. Keeping someone from killing themselves in the first 36 hours of a crisis is a cakewalk compared to the daily ins and outs of dealing with mental illness.
December 21, 2016
I really enjoyed this book about an ER Psychiatrist. In addition to providing interesting case studies, the book touched on the practice of psychiatry, as well as legal and social issues. I felt that it provided a comprehensive look at the experience of the author in his field. This is one of the better books I have read on the subject.
May 4, 2010
I desperately wanted to love this book.
First, because how can you not love a book that starts with "I love my job when I'm not there."
Second, because that sentence resonated with me in very significant ways. I do what Dr. Linde does, sort of.
I commit people.
To psychiatric hospitals.
The book is good. Dr. Linde works very hard to teach as well as entertain. I wasn't expecting references and a bibliography when I started reading. I was expecting vignettes of his work, his coworkers, his patients, set in the psychiatric emergency service. I got some of that, but not enough to satisfy me. I hunger to know what other people in other parts of the country are doing ... the preface had me at the first sentence, but the rest of the book left me hungry. I think I could sit with Dr. Linde and swap war stories over a couple of beers, but I'd keep trying to prod him back to telling me about the PES, rather than the introductory approach he takes through his residency, his moonlighting at the lockup, etc. I want the juicy, smelly, heartwarming, sad, and downright funny stories about people, not just instruction about their symptoms.
First, because how can you not love a book that starts with "I love my job when I'm not there."
Second, because that sentence resonated with me in very significant ways. I do what Dr. Linde does, sort of.
I commit people.
To psychiatric hospitals.
The book is good. Dr. Linde works very hard to teach as well as entertain. I wasn't expecting references and a bibliography when I started reading. I was expecting vignettes of his work, his coworkers, his patients, set in the psychiatric emergency service. I got some of that, but not enough to satisfy me. I hunger to know what other people in other parts of the country are doing ... the preface had me at the first sentence, but the rest of the book left me hungry. I think I could sit with Dr. Linde and swap war stories over a couple of beers, but I'd keep trying to prod him back to telling me about the PES, rather than the introductory approach he takes through his residency, his moonlighting at the lockup, etc. I want the juicy, smelly, heartwarming, sad, and downright funny stories about people, not just instruction about their symptoms.
March 28, 2010
This book's a real winner -- everything I had hoped the terribly overrated would have been. The author, who works at a psychiatric emergency room, presents a series of essays with examples of experiences he often encounters in his line of work: residual schizophrenics suffering from homelessness as much as mental illnesses, long-term unrepentant drug addicts, evaluating an attempted suicide as a possible candidate for organ transplantation, etc. Each chapter flows pretty smoothly into the next, but they could stand alone; in fact, I read them somewhat out of order.
I feel like I learned a lot, which is something, since I've read so many books on the same subject. I can certainly understand and empathize with the author's issues with the subject of treating sick people vs. their right to make their own medical decisions. In addition to all of that, I genuinely liked Dr. Linde. I mean, I think it would be cool to have pizza with him or something, and we would have a lot in common.
So if you're into books about psychiatry and mental illness, I would highly recommend this one.
I feel like I learned a lot, which is something, since I've read so many books on the same subject. I can certainly understand and empathize with the author's issues with the subject of treating sick people vs. their right to make their own medical decisions. In addition to all of that, I genuinely liked Dr. Linde. I mean, I think it would be cool to have pizza with him or something, and we would have a lot in common.
So if you're into books about psychiatry and mental illness, I would highly recommend this one.
May 31, 2012
The law asks too much of an ER psychiatrist--to determine, on a 72-hour hold --who is genuinely suicidal and who isn't. Remarkable that anything can be accomplished in such a short time by way of psychotherapy, but the author tells of several cases in which he succeeded in helping the severely distressed.
February 23, 2012
Amazing book. Inspiring. Dr. Linde does a good job of revealing the horrors of psychiatric realities without scaring the reader, and adds enough humor to keep the reader from feelings terribly depressed after closing the book. Excellent read for anyone interested in (or going into) psychiatry or psychology.
September 14, 2014
Very compelling stories, each captivating in their own way. Highly recommended to all who are interested in abnormal psychology. The emergency psych aspect was extremely interesting as it is a lesser-known way to care of people in our society.
March 19, 2014
This book left a very bad taste in my mouth. Not because I licked it or tried to eat it, but the actual contents. people with mental illnesses, psychiatric disorders, or those who have had bouts of depression have historically been treated like a red headed step child from either other people in our society to the medical professionals who are supposed to help them. In the first couple of chapters it seemed that the author and some of his co-workers were really not all that interested in actually helping those that came into the Psyche ER. In fact the one nurse just wanted to medicate everyone so they would just shut up. WTF kind of medical professional acts like that? I understand that working with these types of patients is not easy, but come on have a little compassion.
I was very disappointed in the author at the preface when he wrote, "I love my job when I'm not there". First of all when you refer to this as "your job" then you don't really seem to be in to actually help anyone. Secondly, if it's so horrible than why don't you have a career change? Later on in the book the author showed a few redeeming qualities and that is why this went from 1 to 2 stars. The author showed very little passion in his work and just seemed very mechanical. As a Therapist and Psychiatrist he rates pretty low on the ladder of someone I would go to for any kind of therapy need.
I was very disappointed in the author at the preface when he wrote, "I love my job when I'm not there". First of all when you refer to this as "your job" then you don't really seem to be in to actually help anyone. Secondly, if it's so horrible than why don't you have a career change? Later on in the book the author showed a few redeeming qualities and that is why this went from 1 to 2 stars. The author showed very little passion in his work and just seemed very mechanical. As a Therapist and Psychiatrist he rates pretty low on the ladder of someone I would go to for any kind of therapy need.
November 20, 2018
For the most part, I enjoyed this book and appreciated something of an inside look at emergency psychiatric medicine. It wasn't altogether detailed and could have included more discussion of ethics, training, consultation, etc., but I'm a little surprised at some of the criticism the book has received. I'm in my first year of clinical training for therapy with a high-risk population, and the professional and personal challenges involved have honestly been more demanding than I knew to expect. For that reason, I enjoyed this book and the natural way Dr. Linde writes about his work, his patients, and some of the lessons he's learned. There's academic and personal interest for me in the self-reflections of someone who's been in a halfway-related field for so long, and I found that this book was an enjoyable read and generally encouraging for a clinician in training.
February 1, 2011
It was a good book to read since I do work with people who have mental illness. It was nice to get a psychiatrist's perspective on it. I think my favorite line of the book was when he said if you have 100 psychiatrists and each one does a different treatment for the same illness all treatments could be right and all could work which is much the same way I feel about social work sometimes because it is all very subjective and you sometimes have to go with your gut instinct. It was nice to see a medical doctor thinking the same way.
May 21, 2020
This book can feel a bit disorganized and dated at times, and I found myself spacing out a bit, but there were some thoughtful/helpful portions which made it worthwhile to commit to. As a mental health counseling intern, reviewing landmark cases which lay out a patient’s right to treatment vs. right to refuse treatment, and the legal foundations of baker acts/5150 holds. It was also a good refresher and resource for suicide assessments. His own experiences added depth to this information as he illustrated ways his own tendencies and thought processes interfered with his judgements. I only wish he might have gone deeper, especially considering the epilogue which was beautiful, in its explanation and poetic description of empathy’s healing power, however Was only addressed in an oblique way in the anecdotes. I hope Linde writes another book in which he uses anecdotes more pointedly to illustrate principles of empathy similar to how Yolam engages existentialism in his anecdotal books...
April 6, 2013
I currently work as a social worker in a psychiatric emergency room. It is an amazingly intense job sometimes, and it's also fascinating how quickly all the incidents and stories become normal. When I saw this book, I had to have it, because I am so interested in what other people say about this work. I also have a deep respect for psychiatrists, at least, those who are willing to work with the patient and help the patient as opposed to just managing medication.
I liked this book. I did. I wanted to love it, but I liked it well enough. If I'm being really honest, there were several times I got annoyed with Dr. Linde, just because he seemed really interested in talking about what a cowboy psychiatrist he is and how he basically uses his amazingly intuitive gut to make all his decisions all day long. He's like the Teddy Roosevelt of psych doctors.
But I wasn't annoyed by him enough to dislike him. I think he genuinely wants to help people, and I appreciate that. It's hard to write a book about your career and come off as both somewhat intelligent and competent and humble. I liked that he was honest, especially about his admitted arrogance in the beginning of his career. I liked that he was so honest about mistakes. And there is something a little cowboy-esque about working in a psych ER. It is messy and dirty and you do have to roll your sleeves up and genuinely want to be there, and want to help people and have a deep respect for the individual and their flaws. Yes, I think he went over the top a few times, but ultimately it seemed a pretty accurate portrayal of life in the psych ER. He seemed to truly respect the people he saw, and that goes a long way.
My one biggest criticism is that the book didn't really give me what I wanted. I wanted stories about patients on the unit, as opposed to just his interactions with patients during interviews. I wanted to hear about the politics of the hospital and navigating the incredibly delicate waters of working with a large staff in a very small, amazingly intense work environment with few resources. Believe me, half the time the patients are the easiest part of working in a psych ER. We got a little of that in the beginning, and I was so hoping the whole book would be like that. The chapter about the jail was interesting, but off topic. The chapter about his experiences with psychotherapy really annoyed me, because I didn't buy a book to read about his foray into Freud's theories. I hate Freud, and I tend to distrust psychotherapy as a whole. So, that chapter really could have been taken out and something else put in there.
Ultimately, it was an interesting read, and I'm glad I read it, and I'll probably go back and reread certain sections at different points. But this is not a book about "Life in a Psych ER." It's a book about a psychiatrist who happens to work in a psych ER, but he's also going to talk about various interactions with other patients at different points in his career.
I liked this book. I did. I wanted to love it, but I liked it well enough. If I'm being really honest, there were several times I got annoyed with Dr. Linde, just because he seemed really interested in talking about what a cowboy psychiatrist he is and how he basically uses his amazingly intuitive gut to make all his decisions all day long. He's like the Teddy Roosevelt of psych doctors.
But I wasn't annoyed by him enough to dislike him. I think he genuinely wants to help people, and I appreciate that. It's hard to write a book about your career and come off as both somewhat intelligent and competent and humble. I liked that he was honest, especially about his admitted arrogance in the beginning of his career. I liked that he was so honest about mistakes. And there is something a little cowboy-esque about working in a psych ER. It is messy and dirty and you do have to roll your sleeves up and genuinely want to be there, and want to help people and have a deep respect for the individual and their flaws. Yes, I think he went over the top a few times, but ultimately it seemed a pretty accurate portrayal of life in the psych ER. He seemed to truly respect the people he saw, and that goes a long way.
My one biggest criticism is that the book didn't really give me what I wanted. I wanted stories about patients on the unit, as opposed to just his interactions with patients during interviews. I wanted to hear about the politics of the hospital and navigating the incredibly delicate waters of working with a large staff in a very small, amazingly intense work environment with few resources. Believe me, half the time the patients are the easiest part of working in a psych ER. We got a little of that in the beginning, and I was so hoping the whole book would be like that. The chapter about the jail was interesting, but off topic. The chapter about his experiences with psychotherapy really annoyed me, because I didn't buy a book to read about his foray into Freud's theories. I hate Freud, and I tend to distrust psychotherapy as a whole. So, that chapter really could have been taken out and something else put in there.
Ultimately, it was an interesting read, and I'm glad I read it, and I'll probably go back and reread certain sections at different points. But this is not a book about "Life in a Psych ER." It's a book about a psychiatrist who happens to work in a psych ER, but he's also going to talk about various interactions with other patients at different points in his career.
June 21, 2014
I really liked this book, for different reasons. It shows the ethical and practical challenges an ER psychiatrist faces, the decisions s/he has to make in relatively short amounts of time, and the responsibilities that go with such decision. I liked the legal explanations and the behind-the-scenes descriptions. I liked the in-retrospect insight Linde provides about some of his cases, the decisions he made, and how he may want to change some of those decisions if he could. I liked that he is a doctor who doesn't only look at the illness, but at the human being behind it. I also appreciated reading about the pain and difficulty people go through. There is so much pain in the world and next door....
January 15, 2011
I love medical oriented books and I have a Masters in Counseling so I was really looking forward to reading this book. Linde shares stories of his time serving as an ER psychiatrist with each chapter focusing on one patient. I felt like Linde had a hard time stepping out of his doctor role and into the shoes of readers without medical degrees. I'm highly academic and I found some of it a bit much, so I don't think this book would hold high appeal for the general populous. I also didn't find it as engaging as I had hoped. There were some really interesting cases though, and he did a good job of examining his own reactions to the patients.
December 21, 2012
Yeah, I was expecting more from it. It just took me forever to get into the book. The first half of the book really didn't interest me at all. It wasn't until the last few chapters that I finally got interested, and even still, it wasn't the most enthralling thing ever.
I guess I wanted more personal stories about the patients or his coworkers or even really about the Psych ER! I wanted the entire book to be more like the last few chapters, which were really patient-oriented.
I was more expecting something along the line of Rob Dobrenski's book "Crazy," (which I recommend, by the way) and that's just not what this book was. Though I think it should have been.
I guess I wanted more personal stories about the patients or his coworkers or even really about the Psych ER! I wanted the entire book to be more like the last few chapters, which were really patient-oriented.
I was more expecting something along the line of Rob Dobrenski's book "Crazy," (which I recommend, by the way) and that's just not what this book was. Though I think it should have been.
February 1, 2010
This guy is an emergency psychiatrist in UCSF's hospital near the tenderloin.
I won't say this is the best-written book I've ever read, but the stories he tells are interesting, and I liked his thoughtfulness about the job he does, the power he holds, and the role society and the law assigns to psychiatrists.
I won't say this is the best-written book I've ever read, but the stories he tells are interesting, and I liked his thoughtfulness about the job he does, the power he holds, and the role society and the law assigns to psychiatrists.
July 14, 2010
Short but thorough patient vignettes for the "educated layreader" about his time in the SF gen psych ER. Currently being passed around my hotel room full of future psych NPs doing rural health in Nebraska because it's a nice mix of solid principles to guide someone's practice as well as a realistic, non-exploitative orientation to the day-by-day of that kind of work.
June 1, 2012
Good book. Enjoyed most of the chapters a lot. I think the completed suicide was the best, the one I could most relate to. I read another book by an ER psyche doctor and I think this one was better. I feel I would actually like this doctor. He doesn't write about his patients with any arrogance or superiority. He seems to genuinely care about the people he treats.
September 4, 2014
A good introduction to an inpatient psychiatric ward, in this case, an urban Psych ER. Nothing new here for those who work in this environment; but for those that don't, this book is an eye opening look at the thorny tangles of legal, ethical, medical and personal issues that arise in this setting.
February 23, 2010
excellent storytelling bringing together the close up stories about the people who end up in psych ER at SF's inner city hosptial, General Hospital, and the realities of psychiatric medicine today and how it has changed over the decades.
July 25, 2015
I was so excited to read this book and what a disappointment it was. The author writing was incredibly disrespectful to his patients. He wanted come across as this great person but instead acted like a jerk!
December 8, 2016
This book normalized my work environment.
April 20, 2023
RICK “SHAQ� GOLDSTEIN SAYS: “I LOVE MY JOB WHEN I’M NOT THERE.�
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The author is more than a Clinical Professor of Psychiatry in the School of Medicine at the University of California, San Francisco (UCSF)� he is a person who prides himself on being an “everyman� despite his educational credentials. He unabashedly wears his heart on his sleeve� in an arena where many doctors, nurses, and administrators have become too hardened by the sad� bizarre� and frightening parade of the human condition that they witness day in and day out. Paul Linde is a doctor in the “PSYCH EMERGENCY ROOM� at UCSF� and with this emotion-dripping memoir takes the reader by the hand through his early days in training through his current veteran status. Dr. Linde quotes famous Doctor’s� mental patients turned writers� writers turned mental patients� personal mentors� and even the Grateful Dead. But what comes shining through� regardless of the situation or time stamp in his life� is his inner soul� his caring and desire� to do the right thing� his empathy� towards fellow human beings� regardless of their stature� foul smell� or hazard to themselves or others� this is the beacon of light� that will continually shine on the reader� regardless of how dark the human tragedy is displayed on these pages.
The hub that all decisions in Doctor Linde’s world revolve around� whether he wants them to or not is CALIFORNIA’S WELFARE AND INSTITUTIONS CODE SECTION *5150* WHICH “PROVIDES FOR THE INVOLUNTARY DETAINMENT OF AN INDIVIDUAL FOR UP TO SEVENTY-TWO HOURS, SO THAT THE PERSON CAN UNDERGO PSYCHIATRIC EVALUATION TO DETERMINE WHETHER HE OR SHE IS A DANGER TO SELF OR OTHERS OR IS GRAVELY DISABLED. THE LAYPERSON CAN EASILY UNDERSTAND THE CONCEPT OF BEING SUICIDAL OR HOMICIDAL. BUT GRAVELY DISABLED? TECHNICALLY IT MEANS THAT A PERSON IS UNABLE TO PROVIDE FOOD, CLOTHING, AND SHELTER FOR HIMSELF OR HERSELF BECAUSE OF A PSYCHIATRIC ILLNESS.�
The ten chapters plus the Preface and Epilogue� are almost like gripping one act plays encompassing parts of life that you can only pray that you or a loved one never go through. All the while� Dr. Linde educates himself and the reader. He has to deal with life and death� lunacy� and scamming alcoholics and drug addicts all day� every day. Are they really hallucinating� or are they acting in order to get a clean bed for twenty-four to seventy-two hours? Did they really want to commit suicide� and if they did or didn’t� are they really going to try again if Linde releases them? If Doctor Linde is wrong� and believe me� there are times he is wrong� and then� there are deadly repercussions. The reader will feel what the Doctor feels when his heart has voted along with his brain in potential life and death situations.
One of my favorite chapters is chapter two “THE ROOKIE: BRUNO’S MAN DOWN� which covers part of Linde’s early training days when he had a very brief limited amount of time to interview prisoner’s who might be suicidal. As he made his way to the pre-ordained cells� there were unabated taunting and screaming from every cell on every floor� but when one of the interviewee’s attempted to take his own life� the change in the entire prison population was like the sea after a great storm. The spreading grief engulfed the inmates in such a way that even an army of prison guards couldn’t have willfully beat it into them.
The reader will be left with a unique feeling towards the doctor and the life he faces on a daily basis. The only way I can describe it� is to share some educational information I received from this book:
“RECENT ADVANCES IN THE NEUROSCIENCES CONFIRM THAT THE EXPERIENCE OF DEEP EMPATHY, WITH ITS ASSOCIATED GLOW OF EUPHORIA, SHARES SOME FINAL COMMON NEUROBIOLOGICAL PLEASURE PATHWAYS WITH NARCOTICS, ALCOHOL, AND CIGARETTES. IN OTHER WORDS, EMPATHY IS ADDICTIVE AND PLEASURABLE.�
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The author is more than a Clinical Professor of Psychiatry in the School of Medicine at the University of California, San Francisco (UCSF)� he is a person who prides himself on being an “everyman� despite his educational credentials. He unabashedly wears his heart on his sleeve� in an arena where many doctors, nurses, and administrators have become too hardened by the sad� bizarre� and frightening parade of the human condition that they witness day in and day out. Paul Linde is a doctor in the “PSYCH EMERGENCY ROOM� at UCSF� and with this emotion-dripping memoir takes the reader by the hand through his early days in training through his current veteran status. Dr. Linde quotes famous Doctor’s� mental patients turned writers� writers turned mental patients� personal mentors� and even the Grateful Dead. But what comes shining through� regardless of the situation or time stamp in his life� is his inner soul� his caring and desire� to do the right thing� his empathy� towards fellow human beings� regardless of their stature� foul smell� or hazard to themselves or others� this is the beacon of light� that will continually shine on the reader� regardless of how dark the human tragedy is displayed on these pages.
The hub that all decisions in Doctor Linde’s world revolve around� whether he wants them to or not is CALIFORNIA’S WELFARE AND INSTITUTIONS CODE SECTION *5150* WHICH “PROVIDES FOR THE INVOLUNTARY DETAINMENT OF AN INDIVIDUAL FOR UP TO SEVENTY-TWO HOURS, SO THAT THE PERSON CAN UNDERGO PSYCHIATRIC EVALUATION TO DETERMINE WHETHER HE OR SHE IS A DANGER TO SELF OR OTHERS OR IS GRAVELY DISABLED. THE LAYPERSON CAN EASILY UNDERSTAND THE CONCEPT OF BEING SUICIDAL OR HOMICIDAL. BUT GRAVELY DISABLED? TECHNICALLY IT MEANS THAT A PERSON IS UNABLE TO PROVIDE FOOD, CLOTHING, AND SHELTER FOR HIMSELF OR HERSELF BECAUSE OF A PSYCHIATRIC ILLNESS.�
The ten chapters plus the Preface and Epilogue� are almost like gripping one act plays encompassing parts of life that you can only pray that you or a loved one never go through. All the while� Dr. Linde educates himself and the reader. He has to deal with life and death� lunacy� and scamming alcoholics and drug addicts all day� every day. Are they really hallucinating� or are they acting in order to get a clean bed for twenty-four to seventy-two hours? Did they really want to commit suicide� and if they did or didn’t� are they really going to try again if Linde releases them? If Doctor Linde is wrong� and believe me� there are times he is wrong� and then� there are deadly repercussions. The reader will feel what the Doctor feels when his heart has voted along with his brain in potential life and death situations.
One of my favorite chapters is chapter two “THE ROOKIE: BRUNO’S MAN DOWN� which covers part of Linde’s early training days when he had a very brief limited amount of time to interview prisoner’s who might be suicidal. As he made his way to the pre-ordained cells� there were unabated taunting and screaming from every cell on every floor� but when one of the interviewee’s attempted to take his own life� the change in the entire prison population was like the sea after a great storm. The spreading grief engulfed the inmates in such a way that even an army of prison guards couldn’t have willfully beat it into them.
The reader will be left with a unique feeling towards the doctor and the life he faces on a daily basis. The only way I can describe it� is to share some educational information I received from this book:
“RECENT ADVANCES IN THE NEUROSCIENCES CONFIRM THAT THE EXPERIENCE OF DEEP EMPATHY, WITH ITS ASSOCIATED GLOW OF EUPHORIA, SHARES SOME FINAL COMMON NEUROBIOLOGICAL PLEASURE PATHWAYS WITH NARCOTICS, ALCOHOL, AND CIGARETTES. IN OTHER WORDS, EMPATHY IS ADDICTIVE AND PLEASURABLE.�
September 27, 2023
The subtitle makes it sound like this is going to be full of excitement and drama and while the author tells us there is, he doesn’t really show us much of it. Instead it is full of large full portions like this :
“Personality disorders are documented as part of a five-category taxonomy by the architects of the DSM, which the American Psychiatric Association and the American Medical Association would prefer that you use when diagnosing a patient. Numeric five-digit codes are assigned to each diagnosis identified in the DSM. Procedure codes are generated in a manual published by the AMA. Insurance companies require a physician to include both diagnostic and procedure codes when submitting a bill for payment. The motivation for organized psychiatry and organized medicine, represented by the APA and the AMA, respec-tively, for publishing these manuals transcends the academic and theoretical realms and enters into the financial--way into the financial.�
Which is not at all what I thought I’d be reading when I picked this up. It was kind of a slug through a lot of it.
2 stars might be unfair since there is a ton of information in it but I had to give it a 2 star because anything 3 stars and higher I would recommend to others - and this book I definitely wouldn’t ever recommend.
“Personality disorders are documented as part of a five-category taxonomy by the architects of the DSM, which the American Psychiatric Association and the American Medical Association would prefer that you use when diagnosing a patient. Numeric five-digit codes are assigned to each diagnosis identified in the DSM. Procedure codes are generated in a manual published by the AMA. Insurance companies require a physician to include both diagnostic and procedure codes when submitting a bill for payment. The motivation for organized psychiatry and organized medicine, represented by the APA and the AMA, respec-tively, for publishing these manuals transcends the academic and theoretical realms and enters into the financial--way into the financial.�
Which is not at all what I thought I’d be reading when I picked this up. It was kind of a slug through a lot of it.
2 stars might be unfair since there is a ton of information in it but I had to give it a 2 star because anything 3 stars and higher I would recommend to others - and this book I definitely wouldn’t ever recommend.
January 28, 2021
Coincidentally, my mom gave me this book and I started working at an inpatient psych hospital a few months later even though that was never my plan! I ended up seeing a lot of paralleled between his stories and what I see in my own job, particularly when he wrote about borderline personality disorder, folks who are malingering, and medically fragile patients.
This was a slow and steady read. Definitely not a “I can’t put it down� read but still enjoyable. It was a good balance between medical/scientific background and storytelling.
The chapter on ethics and organ transplants was really interesting and a somber look into the transplant process.
**adding this review in January 2021/backlogging my old reading journal**
This was a slow and steady read. Definitely not a “I can’t put it down� read but still enjoyable. It was a good balance between medical/scientific background and storytelling.
The chapter on ethics and organ transplants was really interesting and a somber look into the transplant process.
**adding this review in January 2021/backlogging my old reading journal**
December 19, 2020
Linde tells various stories of his experience as a psychiatric physician. There are parts where Linde shows his lack of multicultural competence which are cringe worthy. At one point he states that cultural awareness is a requirement of good assessment- where in a previous chapter he refers to a “malingering Chinese woman.� Despite this, you do see his compassion and a desire to work with clients that many psychiatrists would barely give more then 5 minutes and a scrawled note to. Interesting read that includes care in emergency psych, prisons, and substance abuse clinics.
March 22, 2020
I enjoyed how much I unexpectedly learned while reading this book. It’s more than the stories of the patients; it’s the history of psych, intricate details about various DSM diagnoses, and the logistics and policies that go into hospital procedures.
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