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.

Save the Appendix! A View of DSM-5 from the Trenches
Published on June 1, 2010

When I look at the creation of DSM-5 from the perspective of an ER Psychiatrist, I feel as if I've been left behind, disqualified, overrun by hobby horses.

Epidemiologists ride some; ivory tower denizens can be found astride others; bench scientists at NIMH a few lengths behind but threatening to make a late push; several from each group carrying the insurance industry and Big Pharma's agendas in their side saddles.

However you deconstruct this derby, though, we humble clinicians can be found trampled, face-down in the muck of the stable floo

ay what you will about DSM-III and its offspring through DSM-IV-TR, they've been constructed in a practical and user-friendly way for clinicians. It's not at all evident that DSM-5 will be guided by the principles of clarity or user-friendliness.
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Reviews and Press

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.”

Read the Full Review (PDF)

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."

Read the Full Article


‘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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Paul Linde captures ER buzz in 'Danger to Self'
Katherine Seligman, Special to The Chronicle
Monday, February 8, 2010

The first thing you notice about Paul Linde's small writing office is the quiet. It is the antithesis of the noisy chaos in the psychiatric emergency room at San Francisco General Hospital where he tends to the city's most gravely mentally ill. "It's a struggle to maintain sanity and balance, to be compassionate and not burn out," he said one day recently, sitting in the communal kitchen at the Sanchez Writers Grotto in San Francisco. "I exercise, I spend time with my kids and I write."

Linde's book, "Danger to Self: On the Front Line With an ER Psychiatrist," published recently by University of California Press, is an attempt to make sense of a world that few people see, or want to, he says. The stories are dramatic - so much so there already has been interest from Hollywood. One patient openly declares he wants to kill his boss with a car bomb; another who has slashed her wrist talks about the self-hatred created by her stepfather's sexual abuse. Together the stories narrate Linde's coming of age as a psychiatrist, work that challenges and sometimes overwhelms him and which he views ambivalently enough to start his book by admitting, "I love my job when I'm not there."

"There is a buzz," said Linde, who is a clinical professor of psychiatry at UCSF's School of Medicine. He's drawn to the adrenaline rush, an immediacy that demands that he be present, both in heart and mind. Besides, he said, it's work that is practically part of his genes.

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Author and emergency room psychiatrist Dr. Paul Linde reflects on his book Danger to Self, being in the public eye, and the craft of writing. Read the Blog Post
University of California Press Blog | Monday, February 1, 2010

"Danger to Self feeds our fascination with the world of medicine and our interest in the lives of others. . . . Linde's fast-paced but well-detailed accounts supply the wild, loud, chaotic, smelly and dangerous but also mostly moving "scripts" that could easily be a TV show." Read the full review
Herbert Schreier, Special to The Chronicle | Sunday, January 3, 2010

Linde writes with grace, honesty, and humility about the psychiatrist's task of judging the mind and heart of another human being. . . . Those who enjoy the writings of Oliver Sacks and Sherwin B. Nuland will be enlightened by Linde's compassion and carefully wrought prose. Read the full review
From LIBRARY JOURNAL, November 15, 2009

Linde performs a remarkably successful balancing act by presenting both the theory and practice of emergency room psychiatry in a compelling manner... He's a talented writer and a compassionate doctor who understands what works best for him and his patients: “while my head works pretty well, my real strength as a physician comes from the heart.”
Publisher's Weekly | November 2, 2009

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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Contact

Contact Paul at prlinde@hotmail.com