From the M-POWER Archive:
Gaebler, Hell and Back
Andrew Palmer
Crowning a desolate hill in Waltham, Massachusetts, the Gaebler Children's Psychiatric Unit was a massive complex of four levels. As one entered the lobby on the first level-through the only unlocked door in the complex-one passed by a hall that contained the administrator's offices. This was the portal that separated the "outside" from the larger body of the total institution. At the end of the lobby's corridor one encountered a locked blue door. Strands of metal wire ran through the glass of its large window. On an emotional level, to a child, the message was a profound one. "Immature" minds could not produce a clear verbal formulation which translated its meaning, however. It was a cage.
The office doors of many of the administrators were decorated with posters of pastoral scenes: flowers, fields, butterflies, etc… all those things an incarcerated child would not again enjoy, perhaps for years, or ever again in the same manner previous to passing through that blue door. Superimposed above these images-in sharp contrast to the message implied by that door-were pretentious, trite, warm, humanistic clichés.
The second and third floors were completely occupied by four psychiatric wards, each identical in configuration. The wards were long L shaped halls; on both sides of the hall were various rooms. At the point just ahead of where the L curved was the "social center" of the ward. The staff office and television room there acted as a border, which separated the boy's side of the ward from the girl's side of the ward. The "recreation room" was beside the staff office. It had long ago fallen into disuse, the ping-pong table scarred and splintered, the net broken. It was normally locked. The males' dormitories were located past the office as one traveled on towards the end of the L shape. If one turned around here, as if to go back out, back towards the entrance, one would encounter two locked doors at the end of the corridor where the entrance to the ward lay. These doors were symmetrically opposed to each other one on either side of the entryway. Behind each door was a long corridor of isolation cells.
Within each cell lay only a bare mattress upholstered with green plastic, which was hard and unyielding to the touch. The plastic was designed to be tear resistant. These "beds" usually reeked of urine. Plea's for nature calls were often ignored or not heard, because the walls in this cordoned off area were at least twice as thick as other walls in the building. Loud banging of the children interred in the seclusion area was barely audible outside on the ward.
In my personal experience, I noticed that when a "mental health worker" was invested with unique power over inpatients at Gaebler and the other hospital I went to later; such power often evoked their worst characteristics. The system in these wards called for it's front-line grunts to play superior, and cruel role. At Gaebler these individuals were, in ghastly Orwellian parlance, dubbed "counselors."
The people euphemistically termed "counselors" at Gaebler were generally college kids, in their mid-twenties, some older some younger. A few were still teenagers themselves, eighteen and nineteen. "Counselors" were unquestionably in control: they held long thick cords, which dangled from their belts. At the bottom of these cords numerous, large, medieval looking keys jangled and clinked, thumping loudly, rhythmically against their thighs as they strode the L shaped hall. They were human zookeepers, and if you can conceive of how a human zookeeper views his or her charges, then you might have some inkling of the attitude of Gaebler's "counselors." The ever-present noise caused by their keys constantly reminded the inpatients locked in by those keys, of their entirely powerless, and vulnerable position within the institution. The structure of life arranged at Gaebler and Mass Mental Health Center, was poisonous to the human relationships contained and distorted by it.
Like the cadet who doesn't know the "score" and who "only receives instructions in the moment of transgression" (Theweleit, 1987), the staff at Gaebler through the use of seclusion, kept us in fear and a constant double bind. Apparently there was no clearly defined or enforced policy to guide and prohibit the use of it. The rationale used to excuse most abuse was "we have to keep you safe." However, in my opinion, the real purpose behind the use of seclusion was control. Seclusion and the threat of it empowered the staff as the absolute authority. One could never be sure when or how it would be utilized by them. Factors like their mood that day, or the energy level on the ward, or the unpredictable nature of newer staff members' personalities, were all unpredictable variables, which inpatients needed to learn to gauge in order to look out for their own self-preservation.
Two stories of incidents when I was secluded might illustrate exactly what I mean. In one I "walked" quietly to the cell, as I realized that resistance was futile. The second anecdote is indicative of how seclusion was used as a mechanism of control. It was such an alien situation to me at the time it occurred, I was astonished and could not find the composure to "walk" so I was "carried." In the first case, it was around six in the evening when I was locked in the isolation cell.
A "counselor" who had some kind of personal problem with me, had provoked me. I responded verbally, but emphatically to this man's emotional abuse. I was locked in for this. In the adjoining cell a young girl was screaming and violently kicking the door of her cell. Other cells in the isolation area were empty; he could have placed me in the furthermost one away from her, but he didn't. She screamed his name for a while after he left. The noise reverberated in the seclusion area, like a powerful bass in an adjoining apartment that is amplified, and from which there is no escape. It was worse though, because I knew the girl, she was a human being and it was horrible to hear her unheeded cries for solace and attention.
I endured the noise of her wailing and banging for the next three and a half hours. The "counselor" came and released me at "lights out" on the ward. His eyes gleamed as he said, "Goodnight, Andrew." Numb, I could only docilely wish him "Goodnight, Harold," and quietly walk to my bed.
To relate the second story of abuse of seclusion, I need to provide some background information on another aspect of regulated life at Gaebler, its day school. Each morning, as I lay too groggy to wake, the counselors pulled my blankets off and confiscated them.
The thorazine I was forced to take every evening was not conducive to the mandatory early rising. My warm cocoon stolen, the cool morning air discomfited me. If I was still too tired to rise, I was shaken or literally tossed out of bed. A nurse would then arrive, not long after my narcoleptic wake up call. Every morning she gave me a tiny plastic cup half filled with cranberry juice and the bitter liquid thorazine, which numbed the mouth; a "thorazine cocktail" as this nurse liked to call it. I took the drug three times a day and was compelled to open my mouth wide in order to confirm that it had been swallowed. There was no right to refuse any and all medications prescribed by Gaebler's psychiatrists.
I was woozy and drowsy later at school, and literally passed out daily while there. I remember teachers and other students shouting viciously: "Wake up, Andy!" Their tone seemed to imply that I was committing some sort of crime, which intensely offended them. Often, I refused to go to school and I was placed in an open quiet room and was later restricted to the ward for the next twenty-four hours as punishment for not attending.
If I left the so-called school during the day, I was again placed in the unlocked seclusion room. During these periods I was denied reading materials. I remained in this bare room redolent with the odor of unwashed piss, until classes ended. Then according to the daily structure "quiet time" began on the ward, which was a period of restriction and imposed silence in the dorm rooms; only the dim night lights were left on during this depressing period each afternoon, when the dazzling sunlight-except in winter-was at its peak. After this we went to dinner at the downstairs cafeteria. I learned to avoid trouble later on, when after dinner I would quietly bury my nose in a book till lights out.
Such was the situation the night I was forcibly secluded and "medicated." A staff-member who'd worked on the ward for a very short time and was special to me, someone I had connected with, and had become a friend whom I cherished, had just been terminated and had left for good. Thus I was feeling particularly lonely and needy that night and I really had only one person I felt I could turn to for genuine kindness and support. The staff woman who ran the activities center-which was a recreation room off the ward for kids with privileges from all wards, to go to hangout and enjoy the stereo and sofas-was always able to get me to lighten up and smile. So, even though my privileges were temporarily revoked for twenty-four hours, I took a risk and left the ward to see Diane.
I arrived at the activities center unnoticed, or so I thought. And my unhappiness magically evaporated in the company of Diane, she was doing my mental health a lot of good. That is, until a counselor who had followed me downstairs from the ward confronted me. He told me I had to return to the ward. I asked him to "give me a break it's a quiet night no one else noticed me leave the ward." I explained I'd missed classes earlier because I was too upset to attend. "Rules are rules" he replied. "You know Andy, you can walk or be carried back to the ward. It's up to you."
This was not the first time, I was ever forcibly secluded at Gaebler, but it was the only time, as far as I recollect, in which I was "carried." I couldn't on some emotional level, or because of some principle accede to his demand. I quietly replied that I was not going to return to the ward with him. He placed a call and, overwhelmed, in a nightmarish surreal fog, I heard the intercom announce: "all available help to the activities center…all available help to the activities center…" A dozen or so staff from the various wards raced to the activities center as if they were firefighters zooming towards a mushrooming conflagration. All of them heavier and much taller than my sparse fourteen years old body, they stood before me panting with menace.
I had stepped out of line and, like the practice at the Fascist's military school, I was to be punished for breaking the rules: "Justice works on the principle of equal torment for all…there are no grounds on which a mistake might be considered excusable" (Theweleit, 527). It also seemed, as the Nazis also did, that they were penalizing me because I was reaching out for human warmth. As Theweleit cites:
"Salomen's desire for 'human warmth' grasps at this, having spoken of, (or done something) that which no longer forms or is permitted to form part of the cadets existence. He is treated himself as nonexistent. Salomen is put in the 'shithouse.' Payment is later made in the only valid currency, which is pain" (Theweleit, 531).
"Andy, you have till the count of three," I was told. "ONE-TWO-THREE!"
In a blur of attacking bodies, I was thrown to the floor and physically subdued.
I was carried crying, struggling, and screaming, to Gaebler's version of the
"shithouse." Once there, I was quickly and efficiently stripped
of all my clothing. A nurse then injected me in the buttock with a large dose
of thorazine. One by one, in an elaborately choreographed movement, the "counselors"
released their hold on my naked, weeping, violated body and they exited. A
strong male was the last to hold me. He quickly ran from the room. In anger
I pursued him, only to witness his hostile visage in the small window as he
locked the door from the outside. I had often heard the "all available
help" call; yet this was my first personal experience of the anguish
imposed by it.
I lay naked, crying on the fetid, rough, plastic mattress. As an afterthought, the door opened suddenly and a "seclusion blanket" was tossed at me. Rough and coarse, it was designed with thought that its user might tear a standard blanket into strands with which they might hang or strangle themselves. Cold in the cell, and feeling very desolate and alone, I wrapped the blanket around me until the drug induced sleep knocked me out. I had paid the full price in "the only valid currency." Though this incident was not a sexual act, it now seems to me that I had been repaid for seeking emotional support with a brutal, yet efficient, gang rape.
Today, as I walk through the door of M-POWER's office, I experience the polar opposite in my heart with what I felt back when I walked through the locked entrance of the psychiatric ward. I want to be at M-POWER. I feel trust and affirmation; I realize that other members truly understand. We have all been through many of the same typical horrors. Yet we are not there to be victimized, but as victors we try to effect change.
When, during meetings as part of our campaign for Informed Consent, I have confronted administrators from the Department of Mental Health, it is the only milieu where I have ever felt that it is safe to express anger towards "mental health providers." In whatever measure we are able, M-POWER strives to protect the dignity and humanity of our brothers and sisters in "treatment" across the state of Massachusetts.
Reference material:
Theweleit, K. (1987). "Male Bodies in the 'White terror'." Male Fantasies. 1987, NP. Article appeared in Bartholomae, D. & Petrosky, A. (1993). Ways of Reading. New York: Bedford St. Martin.