Psychiatry and the Dangerous Patient

To the Editor:

Re “Psychiatrists Confront Use of Force” (Science Times, May 21):

I read this article with interest and with sympathy for Matthew Tuleja’s distressing experience; it is a story I have heard many times before. The article mentions that staff members are assaulted, and on inpatient units, patients are also sometimes assaulted by other patients. It is hard in emergency departments where the staff doesn’t know the patients, and who can be talked down and who is truly dangerous.

The article presents the distress from the patient’s (Mr. Tuleja’s) point of view; it doesn’t provide extensive reporting on how scary it must be for a former therapist to hear that an angry football player and ex-patient with homicidal thoughts is coming to confront them. Or what it’s like to be a security guard when that patient charges at an opening in an effort to escape.

At the same time, it is obvious that we need better staffing on inpatient units, and not immediately default to injecting medications and restraining patients. So many people could be de-escalated, but it takes time, patience, staffing and some willingness to tolerate risk. People shouldn’t have PTSD from medical care but they do; this type of treatment weighs on people for years and years.

Having talked to many people about this, and having thought about it for years, I don’t think there is a great answer to this problem. I’m always left with the idea that we should try harder to make inpatient psychiatric care a less stigmatized, less miserable experience for patients, so that going into the hospital isn’t something people dread, resist and say they’d rather die or go to jail before they’d go back.

Dinah Miller
Baltimore
The writer is a psychiatrist and co-author of the book “Committed: The Battle Over Involuntary Psychiatric Care.”

To the Editor:

It has long been known that the incidence of seclusion and restraint in psychiatry varies greatly depending on whether such interventions are considered a necessary part of a patient’s treatment or evidence of its failure.