We all know that most mentally ill people are harmless; they just need treatment. And we also know that most psychologists, psychiatrists, and therapists are pretty tough to unnerve.
But sometimes, it goes the other way.
This piece is based on a Quora Question. Link on the last page.
The vast majority of patients are safe, and I generally never feel “safer” than when Im working with my patients, especially after I get to know them a little.
But early in my career, years ago, I did get a little spooked by one patient – let’s call him Nick. Nick was in his 60s, a widower, manic, and really, really agitated.
I didn’t know how his wife had died.
I was performing his initial evaluation and, like many new doctors, I asked him every conceivable question. When I got to the ‘Social History’ part, I asked about how his wife had died.
He ran up, got inches from my face, and coldly stated: “They say I’m pretty good with a knife.”
The way he said it, for whatever reason, made the little hairs on the back of my neck stand up straight.
Then he abruptly announced that the interview was over and was escorted to his room.
It was only later that staff informed me that his wife had died several years before. Her body was found in a wooded area carved up into little pieces and piled in a neat mound. The killer had (and has still) never been apprehended.
Long ago, I worked in a psychiatric hospital. We worked rotations and usually did six months in one ward. One day someone didnt show up to work, so they took me out of my usual rotation and put me in the most dangerous ward in the hospital.
The outside of this place was surrounded by a 10-foot fence with razor wire at the top. It was one of the only locked wards. These were long-term patients, most of whom suffered from severe psychosis. Most of them were also criminals.
The other nurses in this section were all very big, strong males. I was a small, young woman, but for some reason, I was told to go outside to supervise the patients.
I was sitting next to a rather large female patient, and decided to politely ask why she was in the ward. That was a mistake.
She told me she had killed a cop. I tried not to overreact or show fear, but, well, that was difficult.
Then she said she also enjoyed strangling cats, and followed that up with: just like I am going to strangle you. Then she wrapped her hands around my throat, trying to choke me.
Luckily, there were two of the big male nurses who rushed out and saved me from strangulation. They must have known her history of violence and been watching me.
A colleague asked me to take care of a patient she had been assigned. She said the patient was making her “uncomfortable”. She was visibly upset, but wouldn’t elaborate. This colleague is an incredibly compassionate and competent professional, and I had never seen her this way.
Anyway, when I met the patient, he told me things about myself and my family that he had zero way of knowing. Things no one knew. The patient did not threaten me, he just quietly listed off all of our secrets.
It was terrifying. I excused myself politely and managed to pass on his care to someone else.
This was decades ago, during my internship in the Psychology department. of a state mental hospital. I treated only one patient who really scared me. Let’s call him Hannibal. Not only was Hannibal on a locked ward, he was locked in his room! This was quite unusual.
This was Hannibals 42nd hospitalization. He suffered from severe Bipolar Disorder and enjoyed hitting people when he lost his temper. He was here because he had punched his 18 year old daughter in the stomach during an argument. I was asked to meet with him to determine whether he was a good candidate for individual therapy.
One of the staff unlocked his door and told me to just knock when I was ready to leave. I wondered how long it would be before someone heard me knock – or scream.
Hannibal sat on his bed. He appeared middle-aged, disheveled, and sluggish, with one seriously mean-looking face. I offered my hand and said, “Hi! I’m Rick.” (continued…)
Instead of shaking my hand, he looked at it as if were a dead rat. I sat on the empty bed across from him.
“So, how are you?” I asked.
Hannibal just sat there staring at me. I wondered how long it would take for him to jump up from his bed and kill me.
“Do you think you might want to work with someone on a one-on-one basis?”
He just glared at me. I wondered how long it would take for me to get to the door and break it down with my fists.
“Well, Hannibal, it’s been a pleasure meeting you!” I lied. Then I left.
That evening, I had a graduate class in clinical work. I told our professor and the class about my experience with Hannibal.
My classmates were horrified! Most of them treated clients who suffered from disorders such as Acute Disappointments, Chronic Dissatisfaction and Unmet Expectation Disorder.
The professor listened to my story, and then said: “I want you to do me a favor. See him just one more time. But, this time, don’t feel pressured to draw him out. Say hi but then just sit there and wait for him to talk.” [continued…]
So the following morning, I went back into Hannibals lair. I said hello, sat on the empty bed, and waited.
After about 20 seconds of awkward silence Hannibal frowned and said, So, how are you doing?
Within two weeks, he didnt have to be locked up anymore. He and I began having our sessions while walking the hospital grounds twice a week. Thanks to the medication regimen and his new anger management skills, he was calm and stable enough to be released several months later.
I have never been afraid of another patient or client since.
I only had the experience of being truly afraid twice in my 40-year career. On the first occasion, a client told me that he was planning to shoot his wife with a gun that he had in the trunk of his car.
When I told him that I would have to warn his wife and call the police. He was very angry with me and left the office. This was after 5pm when most of the people in the other offices had left work, so the building was almost deserted. (continued…)
I did call both wife and police, but I was frightened when I left the office on the way to my car. However, thankfully, he was not there waiting for me in the parking lot. Nevertheless I checked the rear view mirror frequently on my drive home. He did not kill his wife, and he never returned.
On the second occasion, a very paranoid patient accused me of making sexual overtures toward him. He was a large and muscular person. He left the office angry and later that day punched a stranger who he passed on the street, accusing the person of the same. He ended up in jail.
I visited him there, but he refused to speak with me. On release from jail, he was transferred to an inpatient psychiatric unit. He was started on medication and was good for a while but went off his meds, hit another stranger, and was jailed again.
My advice for dealing with volatile people is that it helps to be calm, clear and direct with these people, and not to speak loudly. Make sure to have an escape plan and stay at the same level with patient. That is, don’t stand above him, which might be considered threatening or don’t sit when he is standing, in a more vulnerable position.
Its not a good feeling when your patients intimidate you. Fortunately, I learned how to deal with it early from a very good professor who said to me: “why don’t you tell them they are making you afraid?
Once I did that, I was amazed at the results. I was shocked as to how oblivious some people are to how they come across to other people.
Helped me differentiate the really bad ones from those who had more of a conscience, empathy and self-control.
Before I started my first job in mental health I did what any normal person would do: looked at forensic mental health stuff on the internet. And through my perusal I found an incredibly detailed article about a young man who had gouged his own mothers eyes out.
I read about it a bit, then set the paper aside and thought no more of it. the next week, I started my first placement on a psych ward. (continued…)
I was introduced to the ward and the men that were in the unit. One of the young men in particular looked so familiar. But I didn’t want to ask colleagues because there can be issues if you know your patients personally (I thought I might have known him from school).
Weeks and months went by. I tried to just get on with doing my job, but this young man… I was so certain I knew him. I couldn’t get it out of my head.
I could have looked into his records, but I tried to make a point of not reading too much into patients personal histories because it can cloud your judgment.
But finally, I couldnt bear it anymore. So I went and read his reason for admission. His crime: gauging out his mothers eyes. It was him. [continued…]
The guy I had read about before I started. My heart felt like it had stopped in my chest. I wanted to faint.
I was now petrified of him. I knew all the gory details of this guys crime. I knew his diagnosis. I knew everything. I was so scared every time I saw him that I could only smile and ask him feebly how his day was.
But, surprisingly, Im no longer afraid of him. He’s a wonderful patient and he thoroughly enjoys the music therapy sessions we do weekly. He has responded beautifully, and he kind of taught me an important lesson that we all ought to remember.
Mental illness is not always a death sentence. People can change, they can improve. Sometimes they just need help from someone whos not too afraid to be compassionate.
Years ago a pastor from a local church called me and asked if I had the time to fit in an extra client that day. He explained he had been seeing this young man for pastoral counseling and wondered if there was something demonic going on this individual. As a favor, he wondered if I would conduct an initial evaluation and give my impressions of this young adult male.
Now, I don’t know anything about demonic possession and even was skeptical about this pastors assessment, but he piqued my curiosity; so I agreed.
About 8 pm this twenty-something wiry male entered my office waiting room accompanied by his girlfriend. I asked if he wanted her in attendance for the interview or if he preferred she waited in the waiting room. He told me she could accompany us.
I took a seat across from him and began my usual opening questions. He answered them but as the hour passed, I began to get an uncomfortable feeling. He sat slouched in his chair with a sneer on his face. His answers were inconsistent with the history the pastor had given me earlier regarding his situation. His so-called girlfriend was excessively doting which he seemed barely able to tolerate.
I started to suspect that I was being played. His story wasn’t cohesive and felt made-up. The interview began to feel like a setup of some kind in which he was the cat and I was the mouse. [continued…]
Finally, the hour was up and I thanked him for coming in as I walked him and his girlfriend to the office door. Although he failed to identify a clear problem or his desired treatment goal, he wanted to see me again. I politely told him that I didn’t see us as having the necessary fit for an effective treatment relationship. Once they exited, due to feeling ill at ease I locked my office door behind them.
A few weeks later I saw a startling article in the newspaper. This young man had been arrested for allegedly drugging his college roommates and videotaping himself in the act of raping them.
I couldn’t believe it. My gut instinct had been correct; this man was terribly dangerous. I wish I could tell you how I knew except to say that my intuition was sounding the alarm.
Yes, he definitely was the scariest patient I had ever met.
This is a real life incident that happened with my fathers colleague who is a neuropsychiatrist working in Delhi.
He has his own huge clinic where he has hired around 7 psychologists to take the history of patients and he then gives the medications and talks a bit further.
One time, he had a schizophrenic female referred to him by my dad. She came to him complaining that her parents had installed a water tank on the roof of her house so that it would collapse on her and that they wanted to kill her.
The doc listened to her complaints and prescribed the drugs. On subsequent follow up visit, she started threatening the doc about how she would kill him because she knew he was involved in the planning to kill her with the water tank. She had out of nowhere got hold of a pen from his desk and inserted it into his lower arm.
The doc raised an alarm and the girl was taken out.
It’s a really tough job to be a psychiatrist.
You might get killed, but it’s an interesting and relaxing field.
Some years ago, I saw a patient in the hospital where I worked to determine whether he could benefit from any sort of psychotherapy. He was a gang member, and had been shot in a gun battle with a drug dealer, and as a result, was using a wheelchair. In the course of a session, he delighted in telling me proudly how talented he was at hitting people, and knocking them out. He also said if he was going to hurt someone, he would plan it, and then just do it with no warning.
We kept talking, and he revealed something about his family that I believe he hadn’t intended to reveal. I made a comment to encourage him to continue, and he became enraged. He was so angry, he tried to get out of his wheelchair to get at me. I kept my distance, and he eventually calmed down enough to return to his room. A few days later, he brutally assaulted a fragile, elderly man in the hospital for ” not moving fast enough”. He was arrested and sent to jail, and never returned. I have no doubt that he would’ve hurt me if he could have stood up. He was definitely a scary guy.
When I interned at a mental health institute back in 2012, we (the interns) were cautioned about a *violent*female patient who was to be inducted soon into the inpatient facilities. Naturally, we were on guard and as interns, perhaps slightly fearful.
There was another lady residing within the inpatient facilities, who was on her way to recovery and consequently, a discharge a few weeks from then, whom I had been assisting for an hour every day on working out her muscles. Of course, this was not part of my job profile as an intern; rather, it was some extra work that I put in on her request. With the help of a basketball, we worked together on improving the flexibility of her limbs within the confines of her room that she shared with a few others. Our routine involved throwing, catching and kicking the ball.
One day, as I walked inside her room, I noticed a fairly new woman lying down on one of the beds that were lined up across the room. I realized then that this was the newly inducted *violent patient* everyone was speaking of. I went over to the lady whom I was to assist and we began our routine. Over the next couple of days, I noticed the newly inducted patient watch our game silently from her bed. And so, one day, I walked up to her and enquired if she would like to have a throw and catch session with me as well. She said she would like it very much and that she preferred to only throw and catch and not kick the ball. [continued…]
My native language is Urdu and it so happened that hers was as well. We conversed much during our throw and catch sessions and all I recall from my experience at that institute was that she was the kindest of all the people that I had met there. Never did I sense a hint of violence from her. She was psychologically affected due to some issues at home. She was devastated that her son had left her at the mental health institute; how could he? Nevertheless, she continued to speak fondly of him.
She once tried escaping the institute in order to get back home. This action of hers further added on to her tag of being violent.
When I was leaving the institute for good, she asked me if she could have my address so she could meet me someday. I couldnt give it to her as those were against the rules of the institute.
Honestly, my sweetest memories with that institute were associated with the *violent patient* that everyone was asked to be cautious about.
There is an acute ward for patients in the mental institution where I used to work. Patients who had sudden bouts of violence, paranoia, or depression are brought in this ward and are made to stay with a family member.
The treatment is done for three days at which the patient will be assessed on the third to see if they can be sent home or stay for another three days. Family members accompanying patients who don’t get well by the 6th day are asked to provide consent for long term admission.
The acute ward have four huge rooms at the for corners of the building. The three are used for rows and rows of beds where the patients and their relatives sleep and one is used as the pantry. The nurse station is in the middle where we have 360 degrees line of sight.
At around 1am, the nurse that I was with decided to leave me to visit the nurse station at the other buildings to celebrate a colleague’s birthday. I was alone for a while and soon enough I dozed off.
I had my head on my desk when the hair behind my neck prickled. I had the sudden feeling of being watched so I lifted my head, alert.
As I lift my head, my face came in very, very close proximity with a face. I was so surprised I screamed AAARRRGGHH!! as I pushed my body away, my chair almost tumbling down. [continued…]
There was one of our female patients. She had her face pushed toward my desk, apparently observing me.
She calmly stood. Looking annoyed, she said, Stop pretending like you were surprised to see me.
She put her hands on her waist and knowingly told me that her last BP was normal. She said, Tell the doctor I am not hypertensive anymore and I demand to be released.
Having just the fright of my life, I sniggered at how silly her instructions were. I told her I will certainly inform the doctor, but she should have a rest. I brought her back to her bed, woke up her family member to help her sleep.
I had a patient that had stabbed her daughter and during our treatment time she said she now sees me as a daughter. I could not take any risks so I never have unsupervised contact with her anymore. She is a lot less scary but woah. Being compared to a person you killed isn’t the best of comparisons, thanks Mrs.
I worked as a psychologist in a mental hospital for a number of years. I had a patient who we kept in 6 point restraints most of the day and who had badly injured a number of nurses – fractured occipital orbit, broken collarbone, etc. This patient was developmentally disabled and non-verbal. We were unsure of whether or not to diagnose him as severely autistic or psychotic. Since he didn’t speak we couldn’t tell if he was hallucinating, but sometimes it seemed that way. When I would spend time with him I would get a feeling that there was some kind of malevolent intelligence trapped inside him. I shrugged this off as a product of my imagination. Then one day the unit physician and I were reviewing this patients chart and she said to me “you know if we were treating this guy back in the 1600s we would diagnose him as being possessed by a demon. I found this to be an accurate description. The applied behavior analysis we used with him had no effect on his behavior. Eventually, after a lot of bureaucratic hurdles we were able to put him on Zoloft and a small dose of Haldol. These drugs made him more amenable to the behavior plan we established for him and he started to calm down and be less violent. By the time I had stopped working at the hospital he was no longer violent and in restraints. He still seemed like he was possessed but at least his demon was happier.
I went through a prison riot. It was New Years Eve. None of the patients were over 21. Luckily, they were all in locking cells. The noise, the look of hatred on the inmates faces, blurring the distinction of the staff from people whod treated them well, to those whod screwed them over. They didnt care. They wanted us all dead.
I spent the night running from one building in the complex to another, treating self-inflicted injuries as well as diabetic crises, etc. I made sure the C.O.s NEVER let more than two patients out at a time, as we were minimally staffed. They were terrified. I pointed out if the patients killed us, we wouldnt be of any use to anyone.
Because they were ALL ready to kill us ALL, I couldnt use the normal exam room to provide usual care to lacerations, damaged extremities done by breaking or pounding on the cell, etc. This meant limitations to care. One or two patients, who Id known fairly well, came in for treatment, big, thuggy guys with violent histories, with tears brimming in their eyes once we were in the exam room. They had gone along with the planned riot, and swore to kill every staff member possible. [continued…]
There was a big, oversized 18 y.o. who knew he was supposed to kill me, and by doing so, he would lose one of the few people there whod ever showed any compassion to him, whod listened to his life-from-hell story.
I took my time with him, so he could pull himself together. Hed get a beat-down if he didnt kill me, but the rest of the thugs werent his friends either. Dont forget to tell them about the C.O. with the shotgun, I told him. The TWO C.O.s. They were making rounds, and you had a shiv, but you would have been dead by the time it was out of your sleeve.
I wrapped another layer of gauze around his hand where hed smashed the lightbulb and tied it neatly. When he stood up, I patted his shoulder. He asked me for one of his sleeping meds, and I gave it to him, crushed and mixed into juice. He towered over me. We didnt make eye contact when he left the exam room, and we both fixed faces of hate upon each other. For our own safety.
I’m not a psychologist or psychiatrist, however I work in mental health directly with people who have a mental illness. I can’t say I’ve ever feared any of the people with whom I work/have worked with. This could be because I’m a very trusting person, and it could also be that the specific people I know happen to be genuine and good-natured. I have to say the people with mental illness are typically very real and accepting human beings. They’ve been through struggles of their own, so they’re not as quick to judge as someone who has not had the same experiences.
I have to answer this question anonymously, for obvious reasons.
I was a psychiatrist working with young offenders, so Ive met a lot of pretty scary people over the years. But one in particular really stands out in my mind.
He was a boy, barely 18.
When I looked at his medical chart, he was a very bright kid, with an IQ of 140.
But his own parents were utterly terrified of him. They were convinced he was trying to kill them, and apparently he had made several legitimate attempts.
He showed no emotions, and refused to answer any of my questions.
But what scared me the most was when I realized he had actually been keeping himself to an incredibly strict routine – even though he didnt have a clock in his cell. He seemed to have some sort of incredibly accurate internal timetable. [continued…]
For example: he only went to the washroom at exactly 2 PM, 6 PM and 9 PM. On the nose. Every time.
Just before I retired, I visited him one last time, and got the chill of a lifetime when he told me this.
“All this time youve been observing me, but Ive been observing you too. I figured you out easily. But you still have no idea who I am or why I do the things I do. And you never will.”
He was right.