There are many enjoyable aspects to practicing psychiatry. Humor, unfortunately, is not usually one of them. If psychiatrists are not careful, the seriousness of what we do can deplete our emotional energy, and our work can become depressing. Also, psychiatric patients are people, too. Even when they are in a melancholic state, they can still have a sliver of humor left. And, properly-timed humor can be therapeutic, right? So, is it appropriate for psychiatrists and other mental health professionals to joke with our patients? If so, when?
A psychiatric resident wrote a NY Times article about this topic. Interestingly he mentions that when he was an intern on the internal medicine service, he regularly joked with his patients. But, when he started working on the psychiatric service, the humor stopped. He not only felt uncomfortable with the idea of joking with his new patients, but he squirmed when they attempted to joke with him. Ultimately he found a way to joke with a delusional woman in a manner that allowed him to establish enough rapport with her so that she readily gave him her history.
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Several years ago I worked regularly with maximum-security female inmates. I had never really (knowingly) been around violent women prior to that, and it was an eye-opening experience for me.
I worked with many women who had killed their significant others as well as others who had been convicted of lesser but still violent offenses. I realized that while men are statistically more likely to be violent than women, it is definitely a naive and sexist view to assume that women are not violent.
Stalking is simply an extension of the violent potential of women. Women account for approximately 15-20% of stalkers. Statistically, female stalkers are most likely to be single and in their mid-30′s. They typically
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Suicide is an absolutely horrible phenomenon. It destroys families and forever leaves survivors on an elusive search for why it happened. Suicide is often viewed as a very selfish act, yet I believe that in many cases those who do it truly cannot endure the emotional pain any longer and believe that they are out of options. When I was a young adult, an extended family member committed suicide. During my career I have lost a small number of patients to suicide as well. These were all very tragic experiences.
In the United States, mental health professionals have a legal responsibility to take action when our patients appear to be at risk for harming themselves. It is not possible for us to accurately predict when a person is going to commit suicide, but we are expected to assess for and document suicide risk factors. If necessary, we may have to call police or take other action to have patients involuntarily admitted to an inpatient psychiatric unit.
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