Psychologists Talk About The 'Red Flag' Patients Who Truly Terrified Them.

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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.

via GIPHY

This piece is based on a Quora Question. Link on the last page.


1/8. 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.

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.

-Anonymous

2/8. 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. (continued...)


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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 "fing 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.

-Michael Anthony

3/8. 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. (continued...)


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She told me she had killed a cop. I tried not to overreact or show fear, but, well, that was difficult.

The 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.

-Anonymous

4/8. 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.

-NiDonnaNaiz

5/8. 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...)


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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."

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.

-Rick Cormier

6/8. 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...)


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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.

-Bruce Neben

7/8. 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.

-Steve DeBerry

8/8. 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...)


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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 judgement.

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.

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.

-Anoriys Dingwall

(Source)

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