Book Review: Danger to Self: On the Front Line with an E.R. Psychiatrist by Paul R. Linde

What most people know about the psychiatric emergency room is that they don’t want to end up there. In Linde’s latest book, the veteran psychiatrist and writer draws on more than a decade of experience at San Francisco General Hospital’s psychiatric E.R. to show what life is really like behind the locked doors.

A gripping, and at times unsettling, account unfolds. In each chapter,Linde plays a slightly different role: de-escalating a homicidal sociopath, evaluating whether a suicidal young man can be safely allowed to go home, or consulting on whether a recovering drug addict might make a good organ donor candidate.

Linde candidly describes his reactions to both the personalities and personal hygiene of his patients, lending a sense of reality and complexity to the story. He writes just as openly about his frustrations with the public mental health system. His tone carries an off-putting bravado at times but generally conveys the passion Linde feels toward his work.

While Linde’s own experiences practicing psychiatry make an interesting read, it’s the descriptions of his patients that make this book truly compelling. People from all different backgrounds pass through the psych E.R. There are addicts, trauma survivors, psychotics and many high-functioning people who are simply “having one of the worst days of their lives,” as Linde writes. Danger to Self personalizes what it means to have acute mental illness in the United States.

University of California Press, 2010, 253 p., $24.95.