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