Is psychiatry the specialty for the brave? Is there lots of risk-taking needed compared to other specialties? Do you as a psychiatrist feel like a hero?
Is psychiatry risky?
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No. No. No.
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It's hard to kill someone with the vast majority of psych drugs. Very little litigation against psychiatrists. You could give a benzo and switch over to adderall and be be taking wild swings and the patient most likely won't die. You could give both and the patient most likely won't die. It's easy to be incompetent and not get in trouble.
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Until it isn't.
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No. You're mixing up the notion that mental illness equates with violent behavior. It doesn't.
Much of that fear comes from people fearing what they don't understand. You don't understand mental illness yet, so you're more likely to insert your fears of irrational and dangerous behavior.
A very small minority of mentally ill are violent, and that's usually when they're feeling threatened. Overall the risk isn't higher than the general population.
The factors that actually raise the risk of violence are substance use (particularly active intoxication), and psychopathy. You'll see those people in all specialties, but in psychiatry you'll know what to look for to protect yourself.
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The reason I feel unsafe at work has nothing to do with mental illness and everything to do with it being in an impoverished crime ridden neighborhood and lacking in security. It wouldn't matter if I were doing pap smears instead of prescribing haldol. Though maybe specula make a better weapon in a pinch. I don't know.
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This is a great question. If you go back 35-40 years ago no one was talking about "risk" in psychiatry, instead they were talking about dangerousness. The refocusing of the psychiatric gaze on risk mirrors wider trends in contemporary society which sociologists like Ulrich Bech and Anthony Giddens have argued is defined by risk, because modernity had led the production of risk to overtake the creation of wealth, and thus our quest for safety has come to define modernity. This is partly because we have become more concerned about the future and insecurity, both of which generate the notion of risk.
Risk has become a dirty word. Once it was seen as bold, daring, even exciting and occasional. Now risk is seen as foolish, dangerous, threatening and ever-present. I like to joke that I practice "gonzo psychiatry" (though perhaps that is nitemagi's trademark
)
In terms of dangerousness (which I think is really what you are getting at, not risk), I think that people can under- and over- estimate this. Certain kinds of illness are associated with an increased risk of violence - dementia, traumatic brain injury, personality disorders (particuarly paranoid, antisocial and narcissistic personality disorders), mania, depression, substance use disorders (both intoxication and withdrawal). PTSD and psychosis do not appear to confer liability to dangerousness in themselves but add substances into the mix and this increases substantially.
The setting you work in makes a big difference too. If you are working in a nice cash-based psychotherapy practice you have probably screened out the patients who are going to attack you (as the factors associated with this are poor predictors of response to psychotherapy). If you are working in a psychiatric emergency room, a state psychiatric hospital, a poorly run correctional facility (main prisons and jails are quite safe for staff but the mismanaged ones are hazardous), or a high acuity involuntary psychiatric unit then you will more likely be working with violent individuals. That said, just because someone is violent, does not mean they are going to be violent towards you. Violence is rarely senseless or motiveless. One problem is that we have increasingly seen the medicalization of criminality as well as the criminalization of the mentally ill. That is to say that emergency rooms and psychiatric units are increasingly flooded with violent thugs with no major mental illness whereas those (often African Americans) with serious mental disorders are left to rot in our prisons. Community mental health centers increasingly have patients come for court-ordered "treatment" (even though there is no mental disorder to be found, or the person is untreatable).
The environment of the setting also influences the dangerousness. Unfortunately, many places do nothing to respond to violence perpetrated against staff which only worsens the problems. Good workplaces care about their staff and have a zero tolerance policy. Threatening and intimidating staff is not acceptable and rarely explained by mental illness. Too many institutions fail to prosecute or respond appropriately with security and instead expect staff to deal with this. Staff who have more contact with patients, like RNs and behavioral techs are much more likely to be victims of violence than psychiatrists. Part of this is because patients are more likely to see them as all-bad objects conspiring against them.
Finally, individual characteristics influence you're chance of being attacked. It's always the same people who keep getting attacked and it's no accident. If you piss off the patients, you might be asking for it if you get assaulted. Failure to recognize cues to escalating aggression, failure to effectively de-escalate, carelessly placing yourself in dangerous situations (for example not having an exit, not telling people where you are) will make you more liable to be attacked. Failure to recognize the patient's needs and adequately address it, or entering into power struggles will increase your chances of being assaulted. Threatening someone's ego integrity or otherwise confronting needed defenses will also increase your liability for this. If you are condescending, demeaning, belittling, confrontational, intimidating, and threatening yourself - you are much, much more likely to be attacked.
Although psychiatrists overall have a higher chance of being threatened or assaulted, this varies widely between settings and emergency medicine physicians have a higher risk still. Stalking may be more common in primary care, and plastic surgeons are most likely to be murdered by their patients.
Risk has become a dirty word. Once it was seen as bold, daring, even exciting and occasional. Now risk is seen as foolish, dangerous, threatening and ever-present. I like to joke that I practice "gonzo psychiatry" (though perhaps that is nitemagi's trademark
)In terms of dangerousness (which I think is really what you are getting at, not risk), I think that people can under- and over- estimate this. Certain kinds of illness are associated with an increased risk of violence - dementia, traumatic brain injury, personality disorders (particuarly paranoid, antisocial and narcissistic personality disorders), mania, depression, substance use disorders (both intoxication and withdrawal). PTSD and psychosis do not appear to confer liability to dangerousness in themselves but add substances into the mix and this increases substantially.
The setting you work in makes a big difference too. If you are working in a nice cash-based psychotherapy practice you have probably screened out the patients who are going to attack you (as the factors associated with this are poor predictors of response to psychotherapy). If you are working in a psychiatric emergency room, a state psychiatric hospital, a poorly run correctional facility (main prisons and jails are quite safe for staff but the mismanaged ones are hazardous), or a high acuity involuntary psychiatric unit then you will more likely be working with violent individuals. That said, just because someone is violent, does not mean they are going to be violent towards you. Violence is rarely senseless or motiveless. One problem is that we have increasingly seen the medicalization of criminality as well as the criminalization of the mentally ill. That is to say that emergency rooms and psychiatric units are increasingly flooded with violent thugs with no major mental illness whereas those (often African Americans) with serious mental disorders are left to rot in our prisons. Community mental health centers increasingly have patients come for court-ordered "treatment" (even though there is no mental disorder to be found, or the person is untreatable).
The environment of the setting also influences the dangerousness. Unfortunately, many places do nothing to respond to violence perpetrated against staff which only worsens the problems. Good workplaces care about their staff and have a zero tolerance policy. Threatening and intimidating staff is not acceptable and rarely explained by mental illness. Too many institutions fail to prosecute or respond appropriately with security and instead expect staff to deal with this. Staff who have more contact with patients, like RNs and behavioral techs are much more likely to be victims of violence than psychiatrists. Part of this is because patients are more likely to see them as all-bad objects conspiring against them.
Finally, individual characteristics influence you're chance of being attacked. It's always the same people who keep getting attacked and it's no accident. If you piss off the patients, you might be asking for it if you get assaulted. Failure to recognize cues to escalating aggression, failure to effectively de-escalate, carelessly placing yourself in dangerous situations (for example not having an exit, not telling people where you are) will make you more liable to be attacked. Failure to recognize the patient's needs and adequately address it, or entering into power struggles will increase your chances of being assaulted. Threatening someone's ego integrity or otherwise confronting needed defenses will also increase your liability for this. If you are condescending, demeaning, belittling, confrontational, intimidating, and threatening yourself - you are much, much more likely to be attacked.
Although psychiatrists overall have a higher chance of being threatened or assaulted, this varies widely between settings and emergency medicine physicians have a higher risk still. Stalking may be more common in primary care, and plastic surgeons are most likely to be murdered by their patients.
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That's very interesting. Do you know if that is specific to people who seek cosmetic enhancement or is it generalized to all plastic surgery (including burn victims for example)? I would guess the former--which to me is a mental illness, the symptoms of which are both enabled and encouraged by the industry itself. Mental illness might not be the right word since I know it's supposed to exclude culturally normal practices even when they're harmful. I suppose there are some people who for culturally common reasons have unnecessary plastic surgery, and there are some people within that group who are extreme (have repeated surgeries with no reasonable expectation that there could be any socially normalized cosmetic benefit). I have no evidence for it, but I would imagine it's the extreme ones who are more likely to become violent.
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Do you think people who dye their hair when it starts to go grey have a mental illness? People who wear make up? What about shaving one's legs?
People do a lot of things in the name of beauty. Anything can be bad when taken to extremes, but I daresay the vast majority of patients seeking cosmetic surgery are not mentally ill. Or if they are, not for that reason.
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People do a lot of things in the name of beauty. Anything can be bad when taken to extremes, but I daresay the vast majority of patients seeking cosmetic surgery are not mentally ill. Or if they are, not for that reason.
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OP- do a search of the term dangerous and risk in this forum and you'll find it gets discussed at length every few months.
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Well, as I said, mental illness might not be the right word because it's culturally normal. People do irrational things and it's sometimes normal to do irrational things. I wrote a paper on the origins of castrati, and it was once considered normal to castrate young boys because of the beautiful voices they developed in church singing. Now it's considered somewhat normal to pull people's faces back for the appreciation of beautiful appearances.
None of the things you mention risk death from generalized anesthesia. I personally don't think it's sane to undergo anesthesia and surgery for cosmetic reasons. I don't think it's an appropriate use of medical resources, and I don't think it's appropriate that it's even an offering because I think it harms public health (people do die from cosmetic surgery and it's not necessary) and because it encourages the frequent-flier-plastic-surgery patient population, which I think is probably related to body dysmorphia, delusions, or some type of obsessive nature. Surely plastic surgeons being at the highest risk of being murdered by their patients must be somewhat related to this?
What about risk loving physicians? Are there ways to do more riskful deeds if wished in psychiatry, if one is an adrenaline junkie? I don't mean looking for pointlessly extreme situations that are avoidable just for the danger itself; not foolish risk-taking like you mentioned. Emergency psychiatry probably, forensic?This is a great question. If you go back 35-40 years ago no one was talking about "risk" in psychiatry, instead they were talking about dangerousness. The refocusing of the psychiatric gaze on risk mirrors wider trends in contemporary society which sociologists like Ulrich Bech and Anthony Giddens have argued is defined by risk, because modernity had led the production of risk to overtake the creation of wealth, and thus our quest for safety has come to define modernity. This is partly because we have become more concerned about the future and insecurity, both of which generate the notion of risk.
Risk has become a dirty word. Once it was seen as bold, daring, even exciting and occasional. Now risk is seen as foolish, dangerous, threatening and ever-present. I like to joke that I practice "gonzo psychiatry" (though perhaps that is nitemagi's trademark
In terms of dangerousness (which I think is really what you are getting at, not risk), I think that people can under- and over- estimate this. Certain kinds of illness are associated with an increased risk of violence - dementia, traumatic brain injury, personality disorders (particuarly paranoid, antisocial and narcissistic personality disorders), mania, depression, substance use disorders (both intoxication and withdrawal). PTSD and psychosis do not appear to confer liability to dangerousness in themselves but add substances into the mix and this increases substantially.
The setting you work in makes a big difference too. If you are working in a nice cash-based psychotherapy practice you have probably screened out the patients who are going to attack you (as the factors associated with this are poor predictors of response to psychotherapy). If you are working in a psychiatric emergency room, a state psychiatric hospital, a poorly run correctional facility (main prisons and jails are quite safe for staff but the mismanaged ones are hazardous), or a high acuity involuntary psychiatric unit then you will more likely be working with violent individuals. That said, just because someone is violent, does not mean they are going to be violent towards you. Violence is rarely senseless or motiveless. One problem is that we have increasingly seen the medicalization of criminality as well as the criminalization of the mentally ill. That is to say that emergency rooms and psychiatric units are increasingly flooded with violent thugs with no major mental illness whereas those (often African Americans) with serious mental disorders are left to rot in our prisons. Community mental health centers increasingly have patients come for court-ordered "treatment" (even though there is no mental disorder to be found, or the person is untreatable).
The environment of the setting also influences the dangerousness. Unfortunately, many places do nothing to respond to violence perpetrated against staff which only worsens the problems. Good workplaces care about their staff and have a zero tolerance policy. Threatening and intimidating staff is not acceptable and rarely explained by mental illness. Too many institutions fail to prosecute or respond appropriately with security and instead expect staff to deal with this. Staff who have more contact with patients, like RNs and behavioral techs are much more likely to be victims of violence than psychiatrists. Part of this is because patients are more likely to see them as all-bad objects conspiring against them.
Finally, individual characteristics influence you're chance of being attacked. It's always the same people who keep getting attacked and it's no accident. If you piss off the patients, you might be asking for it if you get assaulted. Failure to recognize cues to escalating aggression, failure to effectively de-escalate, carelessly placing yourself in dangerous situations (for example not having an exit, not telling people where you are) will make you more liable to be attacked. Failure to recognize the patient's needs and adequately address it, or entering into power struggles will increase your chances of being assaulted. Threatening someone's ego integrity or otherwise confronting needed defenses will also increase your liability for this. If you are condescending, demeaning, belittling, confrontational, intimidating, and threatening yourself - you are much, much more likely to be attacked.
Although psychiatrists overall have a higher chance of being threatened or assaulted, this varies widely between settings and emergency medicine physicians have a higher risk still. Stalking may be more common in primary care, and plastic surgeons are most likely to be murdered by their patients.
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Heroic, courageous, lovable, while being a dashing dare-devil, yes, every day. Come, join the psychiatry wave.
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And impossibly handsome?
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Someone needs to insert a "World's Most Interesting Man" meme here...but I just don't have time today.
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I found a meme generator....
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While mental illness does not confer dangerousness (excluding antisocial PD or intoxication), it's not fair to say that it isn't associated with violence. Mental illness can impair reality testing and perception of threat by the patient, and treatment environments may restrict the rights of patients. Medical environments are further dehumanizing. All of these together does confer dangerousness, and there are plenty of people who are not suited to be in an environment with such a possibility.
All of that said, it's uncommon for a psychiatrist to be targeted, and if so it's unlikely to result in significant harm.
All of that said, it's uncommon for a psychiatrist to be targeted, and if so it's unlikely to result in significant harm.
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Excellent post. I've always had a general interest in the occupational harms of being a physician generally. People often think about the risk of bodily harm from a patient's assault, but there is almost certainly harm from increased pathogen exposure in medicine as well. I'm very curious as to where you found the statistic re: plastic surgeons, as I've tried (and failed recently) to find reliable metrics like this. There's certainly nothing on physician/nurse M&M from work acquired infections from what I can tell...
so what do you think who risks the most? how are psychiatrists doing compared to others?
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I think music producers risk the most. What are you asking...?
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Nah... its gotta be Acapulco cliff divers.
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That's a pretty good one... or summit climbing Everest style.
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I'm not sure what the source was for it, but in one of the lectures I had during my fellowship, it was mentioned that plastic surgeons are at an elevated risk of being murdered by their patients, so I know splik wasn't pulling that out of thin air. If I recall correctly, this was attributed to plastic surgeons seeing an above average number of patients with personality disorders and also having a lot of patients who are prone to being unsatisfied with their outcomes due to distorted body image issues.
Psychiatry is the healing of the mind. The healing of the spirit. It is not risky at all. In fact I think it is a great honor to measure the mind and develop a medicine or medicine that can bring peace and wellness to a crushed spirit and soul. Music is medicine for the soul. Light is medicine from the Heavens. Light is medicine from within. It is also the medicine of God. Psychiatric medications teaches the spirit to have questions and why scientists and physicians clean the mind with these medicines. Hopefully, they will make a drug without side effects. or with minimal side effects.
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Psychiatry is only risky if you're working with high risk populations. As mentioned above the overwhelming majority of patients are not violent. Several mental illnesses actually lower the risk of violence. If you go into psychiatry you will have the choice to not work with high risk populations.
What I would consider high risk are working on forensic units and ERs. If a clinic were in a veyrybad area of town without security that too would count but that's not a psychiatric thing.
What I would consider high risk are working on forensic units and ERs. If a clinic were in a veyrybad area of town without security that too would count but that's not a psychiatric thing.
