Douglas Berger Tokyo Psychiatrist repsonse to “Practical Tips for Managing the Agitated Patient: Avoiding Violence in the Clinical Setting”

Psychiatric Times

February 27, 2017 (originally published)

Drs Lofchy and Fage write a nice article on violent patients. They rightly note that, “The risk of violence in psychiatric practice is a frightening aspect of our work”. The problem is that few of the many articles like this ever talk about what to do when a punch is on it way, you are getting pushed, or worse, getting strangled.

These articles are great-up to the point of attack assuming that the end-game is pushing a personal panic alarm. However, there needs to be a discussion of what we should do if things get out of hand, if there is no alarm and if security is not around the corner. Actual martial arts self-defense training, which also necessarily entails some offensive practice as part of defense, is the only thing to do next because by definition, all the processes, structures, and verbal de-escalations are not part of the equation at this point. My opinion is that kung fu would be the best training to have, but the best type could be subject to discussion and opinion.

Drs. Lofchy and Fage are right, there is a danger, and psychiatry needs to get over the “political correctness” of the assumption we should never discuss that we should learn how to physically defend, control, neutralize, or even attack back as a defense. Psychiatrists are too cerebral, once a week they need to get into a martial arts gym and train.

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