Riding the stormBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6927.542a (Published 19 February 1994) Cite this as: BMJ 1994;308:542
A few months ago I was beaten about by a patient. Outside the hospital I was shouted at, screamed at, kicked, and punched. I had my spectacles on and my hands were full. This young woman had been threatening my life for some days. Luckily, she was not carrying a weapon. Eventually I retreated between cars into the road and she came at me again. I did not retaliate. After a few more blows I was able to make my escape.
The young woman (I will call her Carol) had been difficult through childhood, and a pattern of self destructive behaviour began in earnest after puberty. There had been occasional violence, mainly towards inanimate objects. She abused solvents, took alcohol to excess, smoked cannabis, cut her wrists, and took overdoses.
She had managed to achieve one or two GCSEs. She was keen on art, particularly drawing. Nevertheless, by school leaving age she had exhausted the patience of her family, who evicted her. Long term outpatient contact and one or two admissions under the child and adolescent psychiatry service probably reduced the extent of her acting out, but also left in Carol a potent residue of antipathy to authority figures and institutions.
Her acts of deliberate self harm tended to be public and demonstrative: the police were often involved. Her appearances in the accident department were frequent. When she turned 17 she came to the adult services …