PREFACE
Psychiatric emergencies arise in a variety of different set-
tings and contexts. A belligerent， intoxicated person brought to
the emergency room by the police， a depressed housewife who
attempts to reach her therapist in the early hours of the morning
because of a sudden upsurge of suicidal fantasies， and an in-
patient who becomes catatonioally excited， all represent situa-
tions where prompt and decisive interventions arc called for. In
such situations the physician must summon up all of his personal
and professional resources to obviate the possibility of a cata-
strophic or even fatal outcome for the patient. The physician
must bring to the fore his knowledge of psychopathology， psycho-
diagnostics， interviewing， psychopharmaeology， and general
medical and administrative know-how， in order to provide effec-
tive treatment. He will also have to call upon his powers of rea-
soning， his common sense， and his empathic and intuitive re-
sources， to resonate best with each clinical situation. An ability
to tolerate anxiety and ambiguity and to blend flexibility and
firmness， as well as a readiness to tactfully contend with fear
and anger， will stand the physician in good stead.
Emergency intervention may require careful listening and
observation， as well as a certain degree of risk-taking and
pragmatism. Emergency treatment can involve thinly veiled
threats to one s self-esteem or personal safety; thus a diplomatic
cautiousness tempered with courage will frequently be required.
One must constantly guard against being either too permissive or
too provocative. Much can be gained through consistently main-
taining a professional demeanor and a necessary degree of au-
thoritarianism. The physician who willingly divests himself of
his dignity， or invites a patient to do this to him， courts trouble.
It is ironic that there arc fewer tangible rewards in emer-
gency psychiatric treatment than there are in other aspects of
psychiatric care， such as psychotherapy. It is no small wonder
that clinicians who choose， or are assigned， to work in emer-
gency treatment facilities so often complain of feeling demoral-
ized and emotionally and physically drained. Emergency treat-
ment can be extremely taxing and time-consuming， which may
explain why some clinicians find it so difficult \"to shift gears\"
and move to this approach when it becomes necessary. After all，
it is more convenient to tell a patient in distress to go to the
emergency room of a nearby general hospital， than to personally
attend to his emergency needs. In order to be fully effective，
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