Drawing on the experience of evaluating over 2000 emergency room patients, René Muller explores the important role of psychiatry in emergency room medicine. He discusses some of his most challenging cases, showing how psychiatry comes to the aid of medicine in managing the crises - real, imagined, and contrived - that are the everyday fare of clinicians who work in the ER. We are introduced to a world in which lies are exposed, manipulations revealed, diagnoses made, medications adjusted, and even very brief psychotherapy attempted.
Muller begins with patient narratives rooted in the mental disorders most commonly encountered in the ER: Depression, panic disorder, drug dependence, bipolar depression, bipolar mania, schizophrenia, and Alzheimer's dementia. These stories pave the way for more puzzling ER cases, which Muller gathers into sections of "Veiled and Bizarre Stories" and "Stories with a Medical Component." He introduces us to the meanings of ER malingering and offers hard-won insights into managing "dumps" (when patients are dumped into the ER by families, police, doctors) and "stumbles" (when patients' bizarre behavior lands them in the ER).
The stories patients tell - and the questions these stories raise - drive Muller's text. A young man has seriously overdosed, but with what? Why has a successfully medicated schizophrenic suddenly begun hearing voices again? And what are we to make of a patient who is willing to risk death attempting to "drown" his hiccups by drinking up to 12 liters of fluid a day? For these and equally fascinating questions, Muller is a sure-handed guide, working his way through one ER challenge after another with psychiatric acumen and a balanced appreciation of the medical, custodial, socioeconomic, and legal dimensions of ER work. An intriguing account of the competing agendas that enter into the handling of emergencies, Psych ER is also a compilation of evocative patient stories about the subjective experience of being ill.
Table of Contents
I. Straightforward Stories
1. Depression: The World Pushing Down
2. Panic: The World Coming Apart
3. Borderline Personality: A Brittle World, A Labile Mood
4. Multiple Personality: Taking on the World with More Than One Identity
5. Alcohol: Chemically Altering One's World by Mouth
6. Drugs: Chemically Altering One'sWorld by Nose and Vein
7. Bipolar Depression: The World Too Low Down
8. Bipolar Mania: The World Too High Up
9. Schizophrenia: Being Unable to Share the World with Others
10: Alzheimer's Dementia: The World Dissolves as the Glue of Memory Cracks
II. Complex Stories
11. Panic Disorder Fed by Emotional Dependence
12. Histrionics Mistaken for Schizophrenia
III. Veiled and Bizarre Stories
13. Malingerers and Manipulators
14. The "Dump"
15. The "Stumble"
16. Murder and Mayhem, Maybe
IV. Stories with a Medical Component
17. Why Is This Schizophrenic Patient Hearing Voices?
18. How a Stomachache Turned a Head
19. A Serious Overdose, But of What?
20. A Closed Head Injury Leads to Paranoid Psychosis
21. A Patient Who Risked Death Trying to Drown His Hiccups
22. Delirium Missed as the Reason for Psychotic Symptoms
V. How Patient's Stories Lead to a Psychiatric Diagnosis
23. The Narrative in Psychiatric Diagnosis: It's the Story, Stupid!
24. Alexithymia: When There Is No Story To Tell
25. Renegotiating the "Contract for Safety"
26. Jean-Paul Sartre in the ER
" 'Psych ER', an easily readable, slim volume, emphasizes the narrative perspective of the life story of the individual. The power of the stories that emerge grip the reader and make it a valuable addition to our literature. The cases that are discussed come alive through such storytelling and offer many useful clinical pearls through these extended vignettes."