Danger to Self: On the Front Line with an ER Psychiatrist
By Paul R. Linde, M.D.
University of California Press, 2010
Review by Jeanne Lesinski

Dr. Paul Linde is an emergency room psychiatrist at San Francisco General Hospital, but it could be any urban hospital because the rules of engagement are the same throughout the medical profession: If a person is judged a danger to to self, a danger to others, and/or is gravely disabled by a mental illness, then this person can be detained for up to 72 hours in a hospital for observation. Linde likens his job in the psychiatric emergency service (PES)  to "diving into the swirl of a cyclone and hanging on for dear life," where he is "one part bouncer, one part traffic cop, one part standup comedian, and one part maître d': 'Sedative, anyone?'" He admits that sometimes doctors and nurses who work in PES have maligned the profession, and part of his goal in writing this "part memoir, part primer, and part commentary" is to humanize not only the mental patients and their loved ones, but the mental health professionals as well. 

To protect patient rights, Linde loosely based this book on his interactions with patients, all the while striving to maintain verisimilitude.  After telling several harrowing tales from his internship and residency at the University of California, he recounts events from his PES work, including working with methamphetamine abusers and patients suffering from lingering childhood traumas. Throughout Linde ponders many ethical questions that plague doctors, yet the philosophical issues and background information that he provides are seemlessly integrated with the rest of this interesting narrative.

Dr. Linde also makes what to readers may be as surprising a discovery as it was for him. By deeply empathizing with his patients and focusing on the moment, Linde brings out the best of himself as a psychiatrist. He explains that neuroscientific research shows that the "experience of deep empathy, with its associated glow of euphoria, shares some final common neurobiological pleasure pathways with narcotics . . . In other words, empathy is addictive and pleasure-able." Discovering this connection between his intellectual and emotional value as a doctor freed him to state: "[W]hile my head works pretty well, my real strength as a physician comes from the heart." To my mind, this is the perfect source.

Danger to Self will appeal to a wide variety of readers, from those wanting a glimpse into the strange scenes behind the lock-down doors of the hospital to others wondering how PES doctors and nurses can psychologically deal with this high-stress job.

© Jeanne Lesinski, 2010