Tag Archives: restraints and seclusion

Just Saying: Restraints and Seclusion are ONLY used as punishment

My response four years ago to an article in CT papers about the use of restraints and seclusion in CT hospitals.

“As someone who has been subjected to more use seclusion and four-point restraints over the past “decade of change” than in the two decades previous it boggles my mind that anyone would even dare to state that things are improving in CT mental health care institutions. During my nearly month-long captivity in the winter of 2013, the Institute of Living in Hartford regularly restrained me to a bed for as long as 19 hours at a time, without ever releasing me for so much as a bathroom break — I had to defecate in my clothing. I was not even released to eat. When I was not in four point restraints “for not following directions, I was in seclusion, which they called the “Quiet Room” and not seclusion, but by CMS definitions, it was seclusion as I was separated from the rest of the patient population by force, and was not permitted to leave the room I was isolated in.

The one time I did actually saunter away, walk down the hall to look out the window, and return to my non-seclusion Quiet Room, I was punished with immediate use of four point restraints, into which I was placed without a struggle, hoping that would make it easier to win my freedom. Alas, for me, there was no way to earn freedom from restraints I never “deserved.” The entire point was discipline, and that would last as long as the staff wanted me to be in shackles to learn my lesson. There was literally nothing I could do, –stay calm, sleep, quietly ask for release — nothing, until they were finally satisfied that I was submissive enough to obey their orders, some 6-19 hours later. But I had to cry Uncle, and submit to a set of degrading humiliating “debriefing questions” that assured them that I took responsibility for my own being restrained and that my behavior would henceforth conform to their norms.

I was surprised to see Natchaug Hospital being given good ratings of any sort. One of their chief psychiatrists on the Adult Unit, a longtime presence their Chief Idiot Emeritus psychiatrist you might say, Paul Pentz MD was so insouciant about this job as to be nearly incompetent, but probably hard to fire even for negligence. HIs name I have mentioned . He routinely did drive-by visits with his patients– a wave in the hallway might not be a completely standard morning meeting, but it happened often enough that peatients knew that would be all of this doctor they would see for the day. He routinely discharged patients with GAF scores at or around 60, the highest “global assessment of functioning” that one can have and still be rated “disabled” — not because he knew this level of functioning to be the case, but because it made him and his psychiatric ministrations at Natchaug look good. After all, if person comes in with a GAF in the 20s, and barely able to function, and you discharge him or her a week or two and some drive-by counseling sessions later with a GAF of 60, you must be doing a terrific job, esp for a 75 year old doctor not too keen on using anything like trauma-informed or patient-centered care. I had never left a hospital before Natchaug with a GAF higher than 40, but suddenly I rated a 60….by a doctor with whom I never spoke.

Natchaug Hospital, when the nursing director was Sharon B Hinton, APRN, was a decent place, because she made certain that abuses like restraints and seclusion rarely to almost never happened under her watch. I know, because I was there about three times during her administration. I also knew her when she was Hartford Hospital’s psychiatric Head Nurse at CB-3, where she and her never failing humanity and respect for the dignity of every patient made all the difference in the world. I might have come from an abusive hospital in the early 90s, like University of Connecticut’s Dempsey Hospital, which in those days four-pointed people to an iron bedstead, by shackling them spreadeagled to the four corners of the bed, a stress position that is not just tantamount to but is in fact torture. But I would be rescued by someone finding me a bed at Hartford Hospital, where Sharon would discover me arriving there in tears and tell me, unfailingly,”Its not you, Pam, you did nothing wrong, It is the hospital that treats you badly…We don’t have any problem with you, because we treat you well and you respond to it. When they treat you with cruelty, you respond badly…That’s very normal.”

But as to Natchaug…Bravo if they have done away with restraints completely. They had not done so when I was there last in 2012. Nor with seclusion, which was imposed in mostly a disciplinary and arbitrary fashion. Largely it was used to force medication on loud obstreperous patients or for angry fed-up senior nurses to take out their peeves on patients they didn’t particularly like (e.g. me). I still remember one APRN demanding that I be dragged to locked seclusion, and left there alone (despite all Sharon’s previous assurances that such would NEVER happen, that someone would ALWAYS remain in that room with me if I ever ended up there.. Alas, Sharon had left by then, so rogue nurses like D could have their way…) and when I peed on the floor in panic, and took off my clothes they rushed in to take them away from me, and inject me with punishment drugs, then made me stay for an hour alone on the pee-soaked mats, freezing cold, pretending to sleep and calm myself just to convince them I could leave and not bother anyone. I managed to do so, or at least the APRN D. got over her fit of pique and finally released me, but I was not really calm, and when they finally draped two johnnies over my naked body so I could decently traverse the distance to my room, I left, disrobing as I went…Who gave a damn about my flabby flat behind? I certainly did not. And it served them right if everyone got an eyeful…served them right..

Natchaug’s biggest problem was and probably still is a lack of staff cohesiveness and bad morale between the staff nurses and the well-educated techs/mental health workers who were all very dedicated college grads but were treated like grunts…The MHW’s did most of the important patient contact, but were not trusted to write patient notes, or the notes they wrote were never read, or accorded any import. This was not just despicable but very unfortunate in more than one instance during my stay, as the notes they took personally might have saved me from some terrible misunderstandings and outrageous misdiagnoses that harmed me terribly..

Most places use techs who are trained by shadowing for a day or two, which means, badly trained, if at all…

You have to take all such in-hospital diagnoses with such a heavy grain of salt, you know, even when they are labeled with the words, “THIS IS A LEGAL DOCUMENT.” Because they get so much of fact-checkable, factual material garbled that you cannot believe a word it says. And as for diagnosis, well it is all of it opinion, one, and two, it depends largely upon whether you are a likable patient or a disliked one, what they finally say about you on any given day. No one should have that sort of power over another human being, frankly. And the idea that they can brand one for life with certain psychiatric diagnoses just sickens me.

Be that as it may, my recent last experience was beyond the beyond, at Hospital of Central Connecticut, The old New Britain General…and I expect to go back to talk to someone there about it. I always do And I have much to say to them, after the pain and rawness have worn off a little. They considered it SOP to strip me naked and leave me alone in a freezing seclusion cell without any access to human contact, unless they chose to speak to me over a loudspeaker hidden in the ceiling. If not, I was utterly abandoned, no contact or even view of another human being for as long as they wanted to keep me secluded. They also restrained me, having male security guards four-point me stark naked to the bed, before they had the decency to cover me with a light sheet, even though I begged for a blanket for warmth. (A nurse manager came in and shivered, saying “Brrr its cold in here!” but did they relent and let me have a blanket…No, clearly I was not human, didn’t need warmth.)

This is just the tip of the SR iceberg in CT in the current years, Remember this is happening right now, not ten years ago, or before the so-called reforms. Nothing is getting better. Things are worse than ever, And when you are a patient in these hospitals, you have no help, no recourse, anything and everything can be done to you and you have no way to refuse or say “no”. No one will help you, or offer assistance. They can just grab you and seclude you or restrain you without your having the power to stop them or any recourse to make them pause and reconsider. You are powerless to stop anything…And so they get away with it every time. And once it is done, who will fight for you? What lawyer will take your case if the guards hurt your shoulder rotator cuff, or bruise you up, or degrade or humiliate you? No one….so you are deprived of your human and civil rights, completely, but the hospital knows that no one cares enough to fight for you, so they get away with it each and every time, and they know this when they do it. They have nothing to worry about,….You are just another mental patient, a nobody, a nothing.

That’s what you are if you are diagnosed with schizophrenia and hospitalized in CT hospitals in 2014. A nobody that the hospitals can abuse with impunity and will. Just wait and see if any of this changes…I doubt it highly. They have no motivation to change. They don’t think they are doing anything wrong now.”

New Poem by Pamela Spiro Wagner

FIXING YOU – A REWRITTEN POEM

Recalling my month-long “treatment” at New Britain Hospital a.k.a Hospital of Central Connecticut on Grand Street, in May 2014, under the supervision of Dr. Michael E. Balkunas

 

Naked in restraints in New Britain Hospital 2014

 

 

 

 

 

 

 

 

 

Only nine days after that last adders-pit hospital —

You still wear sunshades to protect others from you

though no one out here believes they are in peril.

 

Nevertheless, the staff there described you

as “assaultive,” dangerous to self and others,

unfit for company or visitors.

Neither accurate nor truthful

they wrote lies for the sake of their convenience.

 

Now you are a week from making new friends

in far northeastern Vermont,

in a place magically named the Kingdom

and it’s a move your bruised mind

requires, still unable to let go of

the half-nelson grip of hospital guards

bent on eliciting pain, who, when told to strip you

then four-pointed you naked to a mattress,

replaying their favorite rape scene,

yanking each limb apart to expose and humiliate, knowing

that the nurses’ own official policy was hands-off

and would protect their asses.

 

You want truth, you wish for reconciliation

but how, you wonder, does any Truth or Reconciliation proceed

when so many refuse to acknowledge

that hospital staff broke every rule,

stopping short of murder only

because you submitted nick of time,

your terror strangled in a towel they wound

around your head and face,

before they injected punishment drugs into your buttocks,

then muted the intercom and sealed the door

 

No one was ever there to bear witness.

That was always the point,

from your father to the hairdresser

and all the hospital staffs in-between.

They’ve made a religion of secrecy

and no one Outside wanted to know

what they didn’t want to know…

 

Call this, “our family business,”

call it, “a private shampoo,”

call it, “necessary treatment.”

they could always do what they wanted to you.

 

And when it broke you, as it eventually would,

when your sudden screams split the night,

and no one could explain what drove you

to empty your lungs,

ripping the air to shreds,

they stood aside and declared you

just “one of the family” now,

no better and no different than anyone else,

now that they’d finally fixed you for good.

 

Psychiatrie Macht Frei…(huh?) Art Work

All i can say is everything in this picture was as deliberate as i know how to make it, without planning it at all, and it contains symbolism both public and private. With reference to my signature quotation, (see below)  it makes use of what the negative spaces  offered me without leaving any in the end.

“There is no negative space, only the shapely void. Hold your hands out, cup the air. To see the emptiness you hold is to know that space loves the world.” P. Wagner

(for those who are not familiar with WWII, over the gates over Auschwitz, the notorious concentration camp where Jews and many other despised groups were taken to be tortured and killed, were emblazoned the words: ARBEIT MACHT FREI, or “work will set you free,” which was of course a lie and a horrible joke, because it was only meant to kill you at what was not a labor camp but just a death camp. )

PSYCHIATRIE  MACHT  FREI?

Psychiatrie Macht Frei? Mixed media anti-psychiatry picture, 24"by 19"
Psychiatrie Macht Frei? Mixed media anti-psychiatry picture, 24″by 19″

Psychiatrie Macht Frei? Mixed media anti-psychiatry picture, 24″by 19″

OPEN LETTER TO JOSEPH LASEK MD: I FORGIVE YOU

Dear Dr Joseph Lasek, as a recent Alyssum guest, i loved your testimonial on the Alyssum website. Your compassionate writing painted an entirely different picture of the man who just a year ago signed an order refusing to release me, a woman who had not been able to speak aloud for days, (indeed i have a history of having been completely mute for months at a time) from 5- point restraints until i spoke out loud.

Yes, the nurse Annette Brennan wrote that order, and informed you not only that i could speak but that i “refused to” and so you, yourself told me in no uncertain terms, that i would remain in restraints until i obeyed your orders.Despite lying quietly and complying with the restraints, triggering an assessment every 15 minutes, your staff refused to ask me the necessary questions to remove even one restraint and left me alone in that room, time after time, motionless and mute, all because they and you had decided to force speech out of me.

Why? Did you believe you had the right to do this? What had i done to you to make you so angry with me? Why didn’t i have a right to communicate however i chose to or needed? I understand that you believed that i *obstinately* refused to speak to you…and you may continue to choose to hold that belief. I cannot change how you think and i refuse to defend my muteness in the face of your ignorant assumptions.

What i will assert is that the use of restraints has never been or should never be about the power you hold over one of your patients, and it should never be about your power to force a patient in restraints to do something you want her to do. In most parts of the world, and in most people’s minds, for you to force me, by means of physical coercion, to speak out loud would be called torture. What else is it?

What did it matter really why i did not speak? So what if i was obstinate, or unable to form words…neither reason matters a fig. Your only justification in keeping me restrained was if you knew or had determined by communicating with me that i was a danger to myself or others. But time and again, you did not even try to find that out, no.

You assumed things, yes, you assumed that if i kicked the nurse, whose groin inappropriately pressed against my bare feet, a sexual maneuver on her part, that i was aggressive. But you refused to ask me what happened or how i felt or what was going on. You used none of your apparently great capacity for empathy when it came to finding out from me what was going on and how to end the situation as quickly as possible (as you claimed was your desire).

If you really wanted me out of restraints asap, why did you refuse to let me communicate in any fashion except speech. You would not even phrase your sentences in such a fashion that i could answer them with a shake or nod of my head.

So this went on for hours, my frustration and anxiety growing since i was told you refused me even 1/2 mg of Ativan for sleep, for mercy sake. Finally nurse Manusukhani asked me the safety questions at 5:00 am and i answered them all, still mute, but satisfactorily. But the restraints were not removed. No, i was left alone for another hour. When the nurses returned they wanted me to write an essay with a safety plan with one hand, upping the humiliation and degradation till i could not take it any more. I simply shut down and refused.

You won, then. You broke me. I have suffered from that torture every day since that night, a year ago. i did not speak aloud that night, and the next shift took me out of the restraints even though it contravened your orders, because they understood it was an illegal order.

How did you feel about that, feel thwarted, angry? Probably, since you had not been able to successfully break me, break my back and force me to speak…sorry, sorry sorry,

The thing is, my speaking had nothing ever to do with you nor my refusal to speak, that was always only your interpretation. Alway only yours and the nurses interpretation. No one ever asked me why i did not speak, they just made assumptions and always they had negative connotations,,,

Why did they always think the worst about me? They knew nothing at all about me. Dr Malloy had never taken any history, and never talked to me, except to talk at me and dictate to me what he would do if i did not obey his orders. What did i do to deserve this? I had an advance directive before i came into VPCH. Did you ever see it before or during the time i was in restraints? It advises to never use restraints or seclusion as i will only get worse and be further traumatized, but it also provided multiple suggestions for what nursing staff can do instead of restraints or seclusion, none were tried in the minutes before Brennan brought that restraints bed into the room.

I think, from your Alyssum testimonial, that you are probably a very nice guy. I liked very much what you wrote there, and i think alyssum is a wonderful wonderful place. I will never go back to a hospital so long as alyssum, is available to me in any fashion. hospitals only and always torture me. People like you misunderstand and hate and torture me, and seem to get pleasure doing so. I do not understand why…

Now i have to tell you, if you have gotten this far, that i have filed a formal complaint against you with the board of medical practice. If i had been been permitted to speak with you and nurse Brennan and the others face to face and use non violent communication techniques to resolve what happened between us, maybe i would not have had to do so. But the psychologist Elliott Benay would not get people to talk with me, as i proposed and instead told me to do what i had to do.

So complaints were filed and the hospital has already been cited for violation of my rights. What will happen will happen. It wont be bad for you, as you can imagine, nothing bad ever happens to doctors, who always walk away from their misdeeds with a slap on the wrist with a wet noodle; their patients suffer the agonies of hell or iatrogenic illness,you know this or you ought to. I dunno what else to say, you are likely preparing a mental defense of yourself and your actions even as you read this, rather than seeing that perhaps i write the truth, and preparing an apology that might go a long way towards healing the suffering you caused me.

Do you think psychiatrists ever apologize for anything? No, i think it is something they cannot bring themselves to do, not to a patient, it would cost them too much pride and suffering, they would rather the patient suffered…

Nevertheless, I forgive you.

Sadly, forgiveness does not seem to heal or help my suffering, or not yet, possibly because i do not believe you will read this letter. Much less respond. Of course you will not respond, who am i but a stupid mental patient?

no, i will tell you who i am. I am a three-time author, one book of mine was a best selling memoir from St Martins Press for many years. I am also an artist and poet, who, if you will forgive me a tiny bit of pride, will one day be more famous than you ever will. Mark my words. *You* may never hear from me again personally, but someday you will see and hear my name often, just wait.

Sincerely, from the 63 year old woman you kept in 5-point restraints last November, because she could not speak.

Pamela Spiro Wagner

–——

so i went to the commissioners hearing to appeal the APS unsubstantiated decision about Annette brennans part in the above, you can find my account of these events elsewhere in my blog if you do a search on VPFH…anyhow, she took umbrage at my asking her not to call me Pam but Miss Wagner, and rubberstamped the Aps results despite my lawyer arguing on my behalf and my presenting a half hour case…here is her decision, which says nothing about the hearing,

img_1534 img_1535

Pamwagg’s Art from the Wonderful “Care Bed” in Northeast Kingdom, Vermont

BioHazard Head and Face with Bugs...first drawing done at Care Bed in St Johnsbury Vt in Nov 2014 by Pamela Spiro Wagner
BioHazard Head and Face with Bugs…first drawing done at Care Bed in St Johnsbury Vt in Nov 2014 by Pamela Spiro Wagner

 

Silent Scream by Pamela Spiro Wagner, 11/2014
Silent Scream by Pamela Spiro Wagner, 11/2014 Drawing # 2

 

Fist Protesting Restraints
Fist Protesting Restraints Drawing #3 (restraints would NEVER be used at Care Bed)

 

Listen Up Collage -- A message more than art.
Listen Up! Free Your Soul! Collage — More a message about my treatment in Connecticut hospitals (never at Care Bed!) than “art” (#4)

 

Rocking Chair at VT "Care Bed"
Rocking Chair at VT “Care Bed” Drawing #5

 

Care Bed Living Room with bedroom in background
Care Bed Living Room with bedroom in background (at night) Drawing #6

 

Mischief and Kitten among Ornaments!
Mischief and Kitten among Ornaments! Drawing #7

TO MY “PROTECTOR” AT THE MENTAL HOSPITAL: NO THANKS!

 Mushroom-Head in Four-point Restraints: Cannibalism as RAPE by Michael Edward Balkunas, MD, the instigator…

Raped at New Britain General Hospital thanks to  Michael Balkunas MD's orders...
Raped at New Britain General Hospital thanks to Michael Balkunas MD’s orders…

TO MY “PROTECTORS” AT THE MENTAL HOSPITAL

You nurses who, wanting a quiet shift, shackled me into four-point restraints: you ought to have known better: violence only begets more violence…

I came to you, broken —

speaking only splinters of syllables –

“ma-ta-o-tam, ma-ta-o-tam..”

on fire to burn down

the house of my body,

for the meaning of my life

but I was not nice,

not nice, not nice, no,

I was not nice and quiet enough

for the balm of art supplies and human kindness.

Your uniforms ex-cruciated me, tying me

me naked to the four corners of a bed

so your eyes could flay me, the silent shame

gouging my brain to a darkness

years later still vacuumed blank.

Nurses, healers, thieves,

racked there, I lay helpless before you,

even as you raped what was left

of my human dignity.

So intent on getting satisfaction,

you violated my soul

with your smirks

and conspiratorial smiles.

Mental Patient Anti-Psychiatry Rap

AAC FILE (MIGHT PLAY WITH INTERNET EXPLORER

TRY ON IPHONE OR IPAD OR APPLE …DOES NOT WORK ON INTERNET EXPLORER…Okay, this may not please everyone and it isn’t exactly ready for Primetime, but if you can’t hear the lyrics (and in any rap song it is difficult to catch all of them the first time, you can read them along below…Enjoy?? Or at least you  will understand, if you are familiar with Wagblog, where I am coming from. Please let me know if this file does NOT play for any reason.

Mental Patient Rap

by P.Wagg

CHORUS:

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy, I ain’t nothing but a nomad

in the white-coats’ lab.

They say fake it till you make it, so I take it, take it, take it,

Careening through a maze of rules that make me wanna break shit.

Sanity won’t save me, nor all the pills they gave me.

Their remedy’s my enemy, so we mad go fucking crazy.

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy, I ain’t nothing but a nomad

in the white-coats’ lab

VERSE 1:

I remember being locked in, tied down, drugged up,

nurses in control of me, rushing me, coercing me.

Worse than their forcing me was all the pills they pushed on me

then Thorazine or Stelazine jammed into my ass cheeks.

Abuse was inexcusable. Psychiatric orderlies

cuffed my wrists and ankles to a bed when I refused them.

Bruising me, mis-using me — and black and blues-ing me,

A/C cold as ice; retaliation taken twice.

Tied down, naked, there, I shit myself but who cared?

Just another everyday mental patient nightmare.

CHORUS:

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy, I ain’t nothing but a nomad

in the white-coats’ lab

They say fake it till you make it, so I take it, take it, take it,

Careening through a maze of rules that make me wanna break shit.

Sanity won’t save me, nor all the pills they gave me.

Their remedy’s my enemy, we mad go fucking crazy.

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy I ain’t nothing but a nomad

in the white-coats’ lab

VERSE 2:

As bad as leather cuff restraints their isolation cell was hell.

so supermax it made me faint, don’t tell me they meant it well.

No one should have dumped me there, hearing voices, terrified

they stripped my clothing off then left me locked alone inside.

and told me that they had the right to keep me there both day and night

or as long as it would take, for me to learn from their mistakes

I might never get out, never get out, never get out, never get out–

but I started freaking out. I shouted, “I will not bow down

to those with nothing more to do than cause me pain, you cowards, you

you have no heart, you’re inhumane. You torture me to entertain.

CHORUS:

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy, I ain’t nothing but a nomad

in the white-coats’ lab.

They say fake it till you make it, so I take it, take it, take it,

Careening through a maze of rules that make me wanna break shit.

Sanity won’t save me, nor all the pills they gave me.

Their remedy’s my enemy, so we mad go fucking crazy.

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, I ain’t nothing but a nomad

in the white-coats’ lab

Verse 3:

Let’s sing ring around the posey-o: “Hospital Guantanamo!”

Isolation, prison SHU, and mental patients just like me who

traumatized and tortured just go c-c-c-crazy, too.

Abuse is S.O.P. from doctors of psychiatry,

Pusher docs who love to dish out electro-shock therapy

and chemical lobotomies, but it’s all about their money.

Crocks of shit! You’re so wack. You psycho-quacks, you pricks

sized us up and tricked us. But didn’t we wise up quick?

We won’t take no more horseshit, we won’t take no more crap

Take your fucking psycho-meds and ram them up your —-!

CHORUS:

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy, I ain’t nothing but a nomad

in the white-coats’ lab

They say fake it till you make it, so I take it, take it, take it,

Careening through a maze of rules that make me wanna break shit.

Sanity won’t save me, nor all the pills they gave me.

Their remedy’s my enemy, so we mad go fucking crazy

C-c-c-crazy, l-l-l-lazy, c-c-c-crazy, mad and bad.

C-c-c-crazy, l-l-l-lazy, I ain’t nothing but a nomad

in the white-coats’ lab

Oh, you know, you know, yes I know you know,

that I ain’t nothing, never been nothing, never been nothing…

I’ve never been nothing, except a lonely nomad

in the white-coated doctors of psychiatry lab

Spoken CODA:

PT:“I want outta here.”

RN: “Uh uh, not so fast. We’ve got your ass for fifteen days.”

PT: “Fifteen days?! No way, José. You can’t keep me here. I want a lawyer!”

RN: “Doctor, we need to calm her pronto. She’s disturbing the whole unit.”

MD: “I agree. Give her 20mg, IM Haldol, stat.”

PT: “What do you want? What’s going on?! No no! Don’t touch me…Wait!

He-e-e-elp! Help me! Please somebody! Help! Help me…!”

Four-point Restraints at the Institute of Living, Hartford Hospital for 19 hours +

Restrained at the Institute of LIving for Not Following Directions....Dr Amy Taylor presiding
In Restraints at the Institute of Living, Hartford Hospital, 2013, for Not Following Directions….Dr Amy Taylor presiding