Why did I choose to work in psych emergency?
Since seven years of psychotherapy hadn't provided me with the answer, perhaps I needed the three years it took me to write DANGER TO SELF: ON THE FRONT LINE WITH AN ER PSYCHIATRIST to answer that rhetorical question.
I discovered this: My decision had much to do with a gut feeling that my style of thinking and relating on an interpersonal level with both patients and staff were tailor-made for the place.
I wasn't obsessive enough to become a psychoanalyst or a researcher. I was a little too glib, a little too forthright, and far too much of a nonconformist to submit to the prevailing doctrines of either of American psychiatry's dominant paradigms twenty years ago, one, the biomedical explosion, rapidly rising, and the other, Freudian psychoanalysis in a gradual decline.
I guess I wanted action. I wanted to see things evolving. I couldn't wait for years of psychoanalysis to pass to see if my patient got better. I couldn't wait for years of slaving away at a research project just to see my name on a few articles, scrambling to ascent the academic staircase.
I wanted results, if not in the next five to ten minutes, at least in the next several hours. I wanted to say the calming words, right here, right now, and choose the ideal medication to soothe an agitated and psychotic patient, preventing him from winding up in four points or slugging someone, getting him started, I would hope, on the way to recovery.
I decided to wade into the messy domain of clinical psychiatry, at its most scrambled in the arena of the psych emergency. The place and the situations force one to make a decision; not much dithering or second-guessing or ruminating can be tolerated. One must rely on gut instincts and common sense.
The work appeals to those of us blessed, or is it cursed, with an odd mixture of low-grade attention deficit disorder and a high tolerance, but distinct need, for maximal stimulation. We are a subset of adrenaline junkies, a term often applied to ER doctors and nurses, paramedics, firefighters, and smokejumpers.
Perhaps we are the couch potatoes of adrenaline junkies.
The nearly impossible challenges made me feel like I was working against all odds, with a chance to figuratively pull a rabbit out of a hat. I made my best effort and let the chips fall where they may. Emergency psychiatry is messy, so squalid that it provides the ideal antidote to my own perfectionism.
Isn't that what the analysts call counterphobia?
Copyright Paul R. Linde, M.D.
