The Case I Can’t Forget is a weekly series that hears from the people working at the coalface of public service about the cases they have carried with them throughout their careers.
This time, forensic psychiatrist Sohom Das writes on the experience of being assaulted at work.
If you have a story you’d like to tell, email firstname.lastname@example.org
As a psychiatrist, I have the dubious pleasure of belonging to a group of professions that could quite feasibly be punched in the face at work. And I have been, more than once.
Many mental health professionals working on psychiatric wards, including nurses, psychologists and occupational therapists, have to trudge into work with the knowledge that there is a small, but very real chance, that they could potentially face aggression or physical assault.
I would not want to be callous enough to make a generalisation that all psychiatric patients are dangerous. Not at all. But a small, yet significant cohort are. In fact, there are secure psychiatric units, with ramped up levels of security, where forensic psychiatrists such as myself work – one of the most famous being Broadmoor Hospital. By definition, these are reserved for the most high-risk patients, with a history of violence linked to mental illness.
For this specific group of patients, their risk is often directly linked to their illness. For example, paranoid schizophrenia typically involves symptoms such as persecutory delusions; common forms of these are the fixed, unshakeable beliefs that others are watching, following, laughing at, or even wishing to harm or kill the sufferer If you were detained on a psychiatric ward and genuinely believed your life was in danger, arguably pre-emptive violence might be a very sane choice.
In my career, I have seen patients suffering with some very bizarre, and occasionally potentially dangerous delusions, including a schizophrenic man in his mid-forties, who was convinced that he was a famous boyband member. To him, anybody who didn’t “recognise” him was part of a conspiracy to keep him locked up so his (non-existent) manager could run off with his (non-existent) millions of pounds. He would lash out at other patients and staff who didn’t concur with his delusions.
Auditory hallucinations (i.e. hearing voices) are fairly common in schizophrenia also, as well as some other mental illnesses. A specific type, aptly named “command hallucinations”, order the sufferer to commit certain actions. They may demand patients hurt themselves or attack others.
I’ve been attacked twice in my career whilst working on psychiatric wards, and both incidents were eerily similar. Both happened early on in my medical career. Both by psychotic men who weren’t even my patients. But one, in particular stands out to me.
It was my very first day as a junior doctor on a forensic, medium-secure ward in north London. I was speaking to a patient in a private interview room in the corner of the ward, when I noticed a young man looking in, seemingly fascinated by me. He kept tapping on the window, waving and smiling. He even interrupted the interview spectacularly a couple of times by bursting through the door and commenting on random topics, mostly related to religion.
I walked out of the interview totally unaware of what was about to follow. The man ran up behind me, punched me in the head and scuttled off. It happened so fast that I didn’t even realise I had been hit. I just found myself on the floor, confused, with a throbbing head. I found out later that the man had Schizo-affective Disorder, a mixture of schizophrenia and a mood illness, such as Bipolar Affective Disorder. He was suffering from a specific type of delusion of misidentification, known as a “Capgras delusion” and was convinced that I was really his abusive stepfather in disguise. To add insult to literal injury, I was actually doing amateur boxing training as a hobby at the time, and what’s the first rule of boxing? Always keep your guard up.
Thankfully, I wasn’t too shaken up. Perhaps because the assault was so sudden, I didn’t have time to process any threat. Being assaulted on my first day was more embarrassing than anything. I had evolved from “One of the new doctors”, to “That new doctor who got punched.”
In retrospect, I don’t hold anything against the young man who attacked me. He was experiencing powerful delusions and, in his mind, his actions were justified. I have been threatened and racially abused by patients since then who were more lucid, and these incidents have felt much more personal and upsetting. It’s important to make clear that I’ve had far more pleasant and non-confrontational relationships with patients over the years than I have challenging ones. And as a forensic psychiatrist, I fully acknowledge that the mentally ill offenders I work with are not your typical patients, and some are more prone to aggression.
But I know of several colleagues who have been seriously injured at work. Being assaulted can, and does, have a profound impact on people’s lives, confidence and careers.
The Case I Can’t Forget is a weekly series from HuffPost UK that hears from those on the frontline of public service about the cases they have carried with them throughout their careers. If you have a story you’d like to tell, email email@example.com.