I went to the Emergency Room at Boston Medical Center on the night of November 29, 2016, seeking admission to a psychiatric facility. I wasn't mistreated by anyone. When I was moved to the psychiatric ER, I also wasn't mistreated by anyone. I met the doctor and told him why I was seeking admission to a psychiatric facility, which he said he would try to obtain for me
A few hours after that conversation, a woman was brought into the psychiatric ER and placed in another room. There seemed to be a lot of male security guards around. She was loud, but she wasn't swearing or verbally abusive. She was clearly terrified by how many people were around her, and she said that she felt that the room she was in was very small for there to be so many people.
I don't know what initiated her admission. What I understood from what she was saying was that she felt threatened by the presence of so many people. She was verbally offered medication to "calm down," and she said that she didn't want to take anything. She continued to express anxiety about being surrounded by so many people.
After the patient had said several times that she felt that there were too many people around her, a female staffperson said "We're going to give you some space." As soon as that was said, the patient stopped yelling, which I felt was a good sign.
There was quiet for a few minutes, and then the patient was apparently approached again, because I heard the patient say that she had felt upset because there had been so many security guards around her. The patient was already starting to de-escalate when she said that; her voice was much less angry and she even sounded conciliatory. Unfortunately, the doctor answered her by saying "That's not a rational reaction," which I felt was exactly the wrong thing for him to say. I understood why the patient had felt threatened by the presence of so many people, and I did not feel that her anxiety was an irrational reaction. I also felt that the patient explaining why she had felt so threatened was her way of moving toward an apology for having been so upset. The doctor's response that her reaction hadn't been rational instantly re-escalated the situation, when an attempt from him to acknowledge that her distress had a legitimate cause and to respond to her attempt to engage in a more constructive dialogue could have continued to de-escalate the situation and might even have resulted in a therapeutic resolution. His response terrified the patient, because she felt that her attempt to be conciliatory and to show awareness of her behavior was ignored so that the people around her could continue to cast her in the role of a difficult patient. She really needed thoughtful understanding at that critical juncture, and what she got instead was denial that anything about the way that she was being treated could have caused a normal person to feel afraid or angry.
The patient immediately responded verbally with increased anxiety to being told that she hadn't had a rational reaction. Within minutes, I heard the doctor say "medication," and then the patient saying "No!" It was clear from the verbal interactions that she was going to be physically restrained and involuntarily injected.
The patient said "NO" over and over, increasingly desperate. She also asked what the medication was, and her responses after that indicated that she initially wasn't told what it was, because she said several times "I have the right to know." She also said "I have allergies" and that she wanted to know what the side effects of the medication were going to be.
It was clear from the physical and verbal sounds that she was being physically restrained; she said "NO" more and more loudly, and there was the sound of struggling. A male voice said, apparently to the doctor "Do you want her on her back or her stomach?"
The patient continued to say "NO" and "I have rights!" A few times, I heard some of the security people laughing, which I really think that people should be told never to do when a patient is being restrained. Someone who is having physical control over his or her body taken away feels rage, shame and humiliation, and the laughter of anyone who is part of taking away that control is inappropriate.
The patient said several times that the restraints were causing her physical pain and cutting off her circulation.
Whatever they initially did to physically subdue her seemed not to satisfy everyone who was involved. At least 20 minutes after she was initially restrained, a male voice asked of another staffperson "Do you want to do 5-point restraint?"
For this page, I Googled 5-point restraint. This is one of the pictures from that search:
I think that, for some people, there is excitement in physically restraining psychiatric patients, particularly female patients, because women tend to be easily physically subdued by contrast to men. It is a low-risk entertainment for male security guards, who also feel morally justified because the violence that they're inflicting happens in a hospital setting. Although nobody was abusive toward me at the ERs that night, and my clinical needs were met, I can't say with certainty that none of the regular staff in the psychiatric ER get vicarious excitement from failing to take action to de-escalate situations before patients get so upset that involuntary physical contact against patients is then authorized by the staff who failed to address the emotional needs of those patients at opportune times.
There should be every effort to obtain a resolution that is not achieved by physical restraints and medication. I don't feel that's what happened in the incident that I heard that night.
It's not an isolated incident for psychiatric settings. People who work in those places frequently turn into people who enjoy watching and/or participating in assault.
Copyright, with noted exceptions, L. Kochman, December 4, 2016 @ 7:14 p.m.
