Helping patients is important, but so is a firm sense of physical and psychological safety and security.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
The first item on the 10 lessons learned for the daily column yesterday, “Social Psychiatric Lessons Learned and Relearned in the Aftermath of the Synagogue Hostage Crisis,” was to welcome the stranger with trust, but to first verify the appropriateness of the trust.1 That referred to the Rabbi of the synagogue in Colleyville, Texas letting in the stranger who asked for shelter in the building, only to have the stranger pull out a gun and take 4 people hostage. Consequently, the Rabbi attributed their successful escape to prior training, but it was not clear whether letting someone into his building in the first place was part of the training.
Now, we do not know what would have happened if the stranger was turned away. Would the “law of unintended consequences” have led to greater carnage somewhere else? Is the real key to focus on prevention earlier?
These seeming paradoxes of opening the door to strangers while wanting to help can take place in psychiatry, too. Certainly, we encounter potentially dangerous patients who we try to help, but can disregard common safety sense, leading to harm. Take the unforgettable example discussed by Richard Sherer in his January 1, 2007 article for Psychiatric TimesTM, “Violence Against Mental Health Professionals: Fenton Death Highlights Concerns.”2 The article reviews when the very well-regarded psychiatrist Wayne Fenton, an expert on schizophrenia, was killed by a new patient with psychosis that he saw alone in his private office on a Sunday morning, September 3, 2006. As the Past President of our American Psychiatric Association, Paul Fink, was quoted in the article:
“The first thing a psychiatrist should learn is that he should get some information when he does the consultation, so that he can get some sense of the presence of danger.”
In the COVID-19 conflict, Anthony Fauci, MD, has had to have extra security, sometimes sleeping in his guest room at home, for protection and screening of who to let into his house.
No wonder, as I discussed in prior Psychiatric TimesTM articles, against my usual tendencies, I was gratefully told not to wear a tie and not to shake hands when I started to work in a medium security men’s prison.
For any helper to do our best work, we need a firm base of physical and psychological safety and security, as well as common sense.
Dr Mofficis an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric TimesTM.
1. Moffic HS, Seeman MV, Gorman J, Reda O. Social psychiatric lessons learned and relearned in the aftermath of the synagogue hostage crisis. Psychiatric Times. January 27, 2022. https://www.psychiatrictimes.com/view/social-psychiatric-lessons-learned-and-relearned-in-the-aftermath-of-the-synagogue-hostage-crisis
2. Sherer RA. Violence against mental health professionals: Fenton death highlights concerns. Psychiatric Times. 2007;24(2).