“OF SPIRITS AND MADNESS: AN AMERICAN PSYCHIATRIST IN AFRICA” Kindle Edition

ofspirits

Get the Kindle edtion of Paul's first book at Amazon today.
In 1993, psychiatrist Paul Linde took off on an African adventure. After five years of working on the front lines of psychiatry in the emergency rooms and city jails of San Francisco, Dr. Linde thought he had seen it all. But little had prepared him for the madness and mystery he found at Harare Central Hospital in Zimbabwe, where dozens of new patients flooded through the doors every week, each one a fresh lesson in psychosis, culture-clash, and compassion.

Written in the spirit of Oliver Sacks, Of Spirits and Madness takes us on an adventure into medicine and the mind. With sensitivity, good humor, and growing insight, Linde tells the stories of his patients, their demons and their difficulties.

Accolades & Awards

Paul Linde, 2011 Media Award by NCPS (Northern California Psychiatric Society)

The Media Award, given to a journalist who brings public attention to issues related to mental health was presented to Paul Linde, MD for his book Danger to Self, documenting the world of a psychiatric emergency room.

Psychology Today Blog

Paul is now blogging for the renowned journal Psychology Today. Click on the blog link to read his posts and subscribe via RSS to the feed.

San Francisco's Homeless Mentally Ill: Still Neglected
Psychiatry's Sickest of the Sick: Abandoned by Public Health Officials
Published on September 16, 2010

The homeless mentally ill in the city of San Francisco have been so visible for so long they've become almost part of the landscape to us city dwellers--essentially invisible people who, for all intents and purposes, have disappeared.

But for visitors, who flock to neighborhoods such as North Beach, the Embarcadero, South of Market, and the Haight in search of a little urban adventure, they can't help but notice both the numbers of mentally ill and the intensity of psychiatric illness on display.

I still see these people. Time and again when I am out and about in San Francisco, I observe many of the "frequent flyers," many of whom I know by name, that I've assessed in the psychiatric ER of San Francisco General Hospital, where I've worked as a physician and psychiatrist for more than 20 years. I've had to discharge many of them back out to the streets because there is no will on the part of the city or the state of California to provide appropriate care to these patients.

In my opinion, this is tantamount to discrimination.
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Reviews and Press

Bush Official John P. Wheeler Murder Case Deepens
The Daily Beast | by Pat Wingert & Christine Pelisek | January 5, 2011

Paul is quoted in this article saying “Friends of Wheeler's told The Daily Beast that they were unaware of any health problems that might be related to such uncharacteristic and bizarre behavior. Paul Linde, an emergency psychiatrist at the University of California San Francisco, said that disorientation that lasts for days can be caused by any number of medical or mental issues, including heart problems, stroke, stress, past mental illness, or a problem with medication.
But Linde said he didn't think that someone Wheeler's age was a likely candidate for a first-time psychotic episode. "It sounds like he had a break from reality, but it is hard to speculate on what could have caused it," he said. While Wheeler's death has been ruled a homicide, police say they are waiting for the results of toxicology tests before announcing a specific cause of death.”
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“Danger to Self” was named on the San Francisco Chronicle's list “Best of 2010 -- Books by Bay Area Authors”.
S.F. Gate.com | December 19, 2010

See the full list

Danger to Self: On the Front Line with an ER Psychiatrist Review
By Mark H. Fleisher, MD - University of Nebraska College of Medicine, Omaha
JAMA Journal of the American Medical Association
Wednesday, August 10, 2010

In DANGER TO SELF psychiatrist Paul Linde takes readers to places few have been. In a book that may humor, shock, or enlighten, readers are taken into the jails and emergency departments that deal with the interface between the institutions of society and citizens in emotional crises or on the slippery slope of mental illness or those playing the role of being danger to themseslves for personal gain. Few psychiatrists are exposed to the near-constant stress of emergency psychiatry. Far fewer still choose these unique theaters for their clinical practice, as Linde did because it suited his temperament. Thankfully some physicians thrive on that life.

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When politics and the law determine psychiatric practice
By Dennis Rosen, MD | Division of Respiratory Diseases | Children's Hospital Boston | Harvard Medical School | Boston, Mass.
CMAJ, May 17, 2010

Dr. Paul Linde, an attending physician with the psychiatric emergency services at San Francisco General Hospital, California, senses sometimes that his work is derided by colleagues in other, more “glamorous” branches of medicine as “meatball... or veterinary psychiatry” and not given the respect it deserves. In this book, which chronicles some of his professional experiences and highlights a number of ethical and moral dilemmas he has had to wrestle with during his career, he defends his professional choice, noting that the work he and his coworkers do “is deeply rooted in respect for the patient. Most of us want to help people who have been left behind and forgotten by society.”

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The Other ER: Human tragedies unfold in the psychiatric emergency room.
By Anneli Rufus, East Bay Express
Wednesday, April 14, 2010

The young man had just had his stomach pumped after downing a hundred ibuprofen and untold quantities of alcohol. The previous day, he'd been dumped by his girlfriend during a transatlantic call. At San Francisco General Hospital, the young man promised Paul Linde that he wouldn't try to kill himself again. Linde, a psychiatrist tasked with deciding whether patients should be retained or released, let him go. Three days later, the young man hanged himself.

Viewing this tragedy through what he sardonically dubs a "retrospectoscope," Linde airs his regrets in Danger to Self: On the Front Line with an ER Psychiatrist, a moving memoir that offers a rare look at SF General's psychiatric emergency room, where Linde and his colleagues strive to help those he calls "society's most disenfranchised and hopeless."

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‘Danger to Self’ a wild yet poignant look into the life of an ER psychiatrist
By Tom Larson, Morris Sun Tribune
Thursday February 19, 2010

Paul Linde still wonders why he does what he does. In the myriad medical careers he had to choose from, why psychiatry? And as his career in the field unfolds, why, in middle age, does he still venture daily into the chaotic, soul-chilling and often dangerous world of a big-city hospital’s psychiatric emergency room?

Linde’s book, “Danger to Self -- On the Front Line with an ER Psychiatrist,” is a vivid look at the patients, staff and politics alive in an environment most people can scarcely imagine, much less ever experience first-hand.

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More Reviews, Press and Articles

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.



Paul R. Linde, MD

Paul R. Linde, M.D., a San Francisco based author and clinical professor of psychiatry at the UCSF School of Medicine, has worked in several high-intensity psychiatric settings over the years. His first book, Of Spirits and Madness: An American Psychiatrist in Africa, was published by McGraw-Hill in 2002. Linde has also written for JAMA, the San Francisco Chronicle, the San Jose Mercury News, and DoubleTake magazine. He lives in the San Francisco Bay Area with his wife, two sons, and a rambunctious one-eyed dog. Dr. Linde's Bio



Articles

A Day in the Life of PES: Twenty-Four Hours at the Psychiatric Emergency Services Department of San Francisco General Hospital
David Elkin, MD; Paul R. Linde, MD; and Eric Woodward, MD | San Francisco Medecine, Journal of the San Francisco Medical Society | "Extreme Medicine" Vol. 82, No. 2 | March 2009

Excerpt:
It's 7:00 a.m., and a group of a dozen men and women-psychiatrists, social workers, nurses, and other mental health personnel-are gathered around a desk in the staff room, per- forming the daily ritual of the morning report in the Psychiatric Emergency Service (PES) at San Francisco General Hospital. A glowing LCD screen-one of few high-tech devices in an otherwise outdated and unadorned space-displays patients' names, diagnoses, and lengths of stay. Almost all of the twenty patients (an average case load) are in PES on an involuntary basis.

The State of California's Welfare and Institutions Code 5150 provides the legal justification for a person to be involuntarily taken into custody for up to seventy-two hours for an evaluation on the basis of being a danger to self, danger to others, and/or gravely disabled on the basis of a psychiatric illness. The PES at San Francisco General is open for business 24 hours a day, 7 days a week, 365 days a year. It is the only designated receiving facility in the city for people placed on 5150 psychiatric holds.

Often, working in PES can be compared to diving into the swirl of a cyclone and hanging on for dear life. The staff adjusts to the velocity and spin enough to manage as many as four equally compelling tasks at the same time. It helps to come equipped with an unusual combination of keen diagnostic skills, a sense of humor, tolerance for ambiguity, and the ability to react quickly to changing circumstances.

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More Articles and Reviews

Contact

Contact Paul at prlinde@hotmail.com