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Maybe 80% of the patients are pretty ‘with it’ – depressed people, very anxious people, people with anger issues who aren’t angry at the moment, people coming off of heroin or something.

The remaining 20% of people who are very psychotic mostly just stay in their rooms or pace back and forth talking to themselves and not bothering anyone else.

But my last time on call, somebody also had a seizure, and I sort of strolled in half-asleep, ordered the necessary tests and consultations and supportive care, then strolled out and went back to bed.

And then there are the little things, like learning to tune out a psychotic guy banging on the window and yelling threats at you. It’s interesting that psychiatric hospitals are used as a cliche for “a situation of total chaos” – I think I’ve already mentioned the time when the director of a psych hospital I worked at told us, apparently without conscious awareness or irony, that if Obamacare passed our hospital would have too many patients and “the place would turn into a madhouse”.

” And he said: “That guy with the wild hair pounding on the window and shouting threats and obscenities at us.” And I said: “Oh, him? Don’t worry about him, he always does that.” The podiatrist seemed inadequately reassured.

I thought about this because as of today I am halfway done with my four-year psychiatry residency.

(there’s another aspect of this, which is that people constantly protest that horrible things will happen to them based on that week.

With very few exceptions, there is nobody so mentally ill that calmness authority the implied threat of burly security guards won’t get them to grumble under their breath but generally comply with your requests, reasonable or otherwise. I’d like to say I’ve taken advantage of this to go mad with power.

But it’s actually a really crappy situation for everyone involved.

Some clever person might ask: “Hey, don’t most psychiatric medicines require more than a week to take effect? The most common type of case I see is “person who was really angry, said ‘I’ll kill myself’ in a fit of rage, and then their partner called the cops and they were brought to hospital.” These people stop being angry after a day or two and then no longer make these comments, even assuming they meant it in the first place which most of them don’t.

The second most common type of case I see is “person who was really angry, did try to kill themselves, and it didn’t work.” Again, these people have stopped being angry.




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