My Psychiatric Advanced Directive — IGNORED at the Institute of Living at my Expense

These are the first two pages, including a note from the cover page, of my very very detailed Psychiatric Advanced Directive, and I think you will see why what happened at the Institute of Living, the psychiatric section of Connecticut’s Hartford Hospital, NEVER should have happened. Not only did I bring a hard copy of this PAD, but I wore a medical bracelet with a code for a very complete online medical record, with uploaded documented evidence, both of narcolepsy diagnosis and need for medication, proof from longtime outside mental health providers that I do NOT have “borderline personality disorder,” and other such assistive documents…ALL were soon ignored completely in the effort to discipline and punish me “for not following directions” i.e. not getting better fast enough and speaking my mind to the psychiatrist.

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Prominent NOTE on cover page:

Miss Wagner has experienced multiple episodes of severe psychological and physical trauma. She must NOT be subjected to either physical or mechanical restraints or involuntary seclusion at ANY time. The use of either imposes a serious risk of re-traumatizing and injury, leading to regression and severe worsening of symptoms.

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HOW TO INTERVENE IN A CRISIS:

DE-ESCALATION IS ESSENTIAL

  1. 1.    PLEASE REMEMBER: I can calm down if YOU follow these steps and do not threaten me, order me around, or approach me in anger or in fear.
  2. I need one person to talk to. I should be approached calmly, by someone who will speak in a kind and respectful manner, understanding that above all:
  3. I AM SCARED and my anger masks fear. I am not dangerous. I WILL ONLY FIGHT IF YOU ATTACK ME. Please remember that any show of force and people ganging up on me to administer forced medication will be felt as an attack.
  4. I can be persuaded to take oral medication, usually, if this is negotiated with dignity and kindness and not by means of threats.
  5. DO NOT ISSUE ULTIMATUMS you won’t back down from…That will push me into a corner and you too, and will serve nothing but to escalate the crisis.
  6. A calm unthreatening and unthreatened person should ask me calmly and patiently if I can speak in a lower tone of voice, so she can hear me better. Ask me if I can take a deep breath and try breathing techniques that will have flown my head in the moment of crisis.
  7. Should you have a COMFORT room available, you can guide me gently to it but do not close me alone. Make sure I am warm…
  8. ABOVE ALL YOU NEED TO BE PREPARED TO LISTEN TO ME. This is not just a matter of forcing medication. Medication may not even be needed if you hear what is going on and what the problem is.
  9. If you take these simple steps, it is virtually guaranteed that the situation will resolve calmly and without any need to resort to the sorts of violence that would permanently damage and re-traumatize me (or produce secondarily negative behaviors afterwards): seclusion, forcible injections, or mechanical restraints or physical holds.

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STATEMENT TO CAREGIVERS

It is vitally important that you understand that despite a few previous in-hospital assessments, I do not have a personality disorder, borderline or otherwise (you can confirm this with any of my longtime outpatient providers) and that if my behavior seems out of control, it is because I am out of control: I literally do not at the time know what I am doing or why. I am not manipulative or attempting to achieve secondary gain. The fact is I have had tertiary CNS Lyme disease and after positive PCR and Western Blot tests during treatment, I was informed the condition is likely incurable. (Dr ******* of ****** NY, will confirm this.) During the initial illness, my brain developed multiple lesions, visible on MRI, which may predispose me to temporary emotional and behavioral extremes and abnormalities but these are NOT my norm. Anyone who knows me well would confirm this, if you asked them.

You need to understand that I am not always able to communicate the extreme fear I feel, the global paranoia that I experience, but because I feel so threatened and unable to communicate clearly about it I may become very angry at the hospital situation. I am not an angry person. I do have trauma issues, as many people do, which may be exacerbated by being in the hospital.

Please be aware in advance that my “memory in the p.m. for what happened in the a.m.”  is often faulty. That is just how it is. When in crisis, I have little ability to recall from moment to moment what happens. This is why it is essential that I be able to write things down. I have lost many years to this amnesia and if I suffer additional trauma it will only make it worse.

I beg of you, do not make assumptions about me. Do not make assumptions about my state of mind. Do not “put two and two together” in your mind without asking me if the conclusion you have drawn is the correct one. You do not know what is inside my head without asking me.

Ascertain whether the information you have at hand is correct. Too many records and hospital charts have been drawn up (because “patient is not communicating”) on faulty information from earlier charts or information gleaned from others but not from me, and the consequences to my treatment have been devastating. PLEASE CHECK MY INTERACTIVE HEALTH RECORD ONLINE at www. — .com Use code ***** to get access.

 

I have been traumatized by abuse, sexual assault and by brutal treatment in hospitals, from being deliberately choked and given forced ECT to being kept in four-point restraints for several days at a time. So if I experience seclusion or restraints or even that euphemistic obscenity called a “therapeutic hold” it will be devastating and counterproductive. Such treatment invariably leads to increased anger, regression and worsening of symptoms, and my behavior becomes unpredictable afterwards. This is a response to trauma NOT because of any inborn temperamental disorder. I have already outlined a better way to deal with me and help me on page 2.

I KNOW YOU MAY NOT APPROVE OF POLYPHARMACY. But you need to understand that I must take the antipsychotic drug combination: Abilify 15mg with Geodon 160mg, a TWO-Drug regimen. Monotherapy does not work. I have tried many solo drugs over the course of 4 decades – Thorazine, Mellaril, Haldol, Prolixin, Clozaril, Risperdal, Seroquel, Zyprexa and others – ALL monotherapy has failed.

I will not take any drug that induces weight gain. If you force the issue, know that it will be a useless endeavor because I will stop taking it immediately upon leaving the hospital.

Finally, understand that if I am here in the hospital it is for a reason, and I want only one thing: to get better and be out of here as soon as possible. You can traumatize me and worsen my symptoms and keep me here too long, or you can work with me to achieve my goal, which should be the same as yours. I don’t see any other alternative.

 Respectfully,

Pamela S. Wagner

Now, I think that is about as crystal clear as it can be, no? And indeed, Dr Banerjee, my first psychiatrist LOVED it. Said so, and raved about how complete both were, both the PAD and the online medical history which he downloaded, printed out and brought with him to our first consultation. So what happened? YOU tell me! I will write more about what I think happened later. I am still trying to figure it all out.

Art created at the Torture Chamber called the Institute of Living at Hartford Hospital

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I was a prisoner at Hartford Hospital’s Institute of Living’s Donnelly 2 South from January 10th until February 7th, 2013, the day before the east coast blizzard, and I only “escaped” because the torturing doctor went on a four day vacation and the substitute decided that I was not actually psychotic any longer and did not need seclusion or restraints after all…and opted to let me go the very day I was freed from both.

 

Good thing too, because it was a Thursday and all travel stopped the very next day and for several days after that. The picture above is one that Shedana, RN liked very much. She said it captured her “physique” and while the flooring is imaginary, the unit was structured much as it is pictured. At least while I had a bed on the unit, with my door facing the med room and another bedroom opposite. Shedana was a “good egg” but of course it didn’t help when they decided to attack me in force and secluded me for two weeks and worse…But more on that later.

 

The first doctor I had merely convinced me to take, semi-voluntarily, a fairly stiff dose of Zyprexa. which I tried to do with regularity. I soon found, however, that far from being the miracle drug it had once been, mixed with Abilify and Geodon it induced a state of apathy and boredom. As if the Intake and Feeding drug, the drug on which I used to feel enthusiasm to learn and read, Zyprexa, simply mixed very badly with the Output drugs of Geodon and Abilify, such that I neither could read and learn, nor do art or write. In any event, this abysmal lethargy pushed me out of desperation to paint this, in oil pastels.

 

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After that, I simply started refusing to take the Zyprexa, and refusing a lot of other things…A great deal of abuse happened. But I did this picture before all my art supplies were confiscated for no reason other than punishment (you cannot damage yourself or others with soft oil pastels)

 

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Before I tell you some of what happened, without naming names, lest a legal case be made against them, as there might possibly be a chance to do, let me show you most of the rest of the art I did there, though one of them is unfinished and may never end up being finished, since it was hospital art and may stay that way.

 

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This one is an oil pastel, me with a dung beetle pushing a ball of shit around on my cheek…Says enough just that, doesn’t it.

 

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This one can be turned any which way to see all sorts of things buried in the picture. It was the one I started first and never did get to finish. What I can point you towards is the central object at the very bottom, which you can trace up to the blue figure and see what is happening. It should tell you something…The hand on the upper left is pointing at this process. Also, the exploding biohazard ball is part of it all, representing me, the all-polluting biohazard…But you have to look at the picture carefully. There is a Boat To Nowhere, and there are a couple of turtles, why, I don’t know…yadda yadda.

 

Finally, the very last time I had access to any art supplies, and I do not recall whether it was my last morning or some other time, I painted this one with oil pastels. I believe it speaks for itself.

 

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What happened was that they were routinely, literally routinely restraining me “for not following directions” as they would quite openly state. Four-point restraints, in a tight no movement position, for many many hours at a time, with absolutely no indication of how, just how, I might “earn” my freedom. Of course they wouldn’t tell me what I could do to “be good” because I hadn’t done anything to ‘deserve” restraints to begin with as they knew perfectly well. For example,. and this was typical, but it was one of the few opportunities I managed to document because they ha removed all my writing materials, illegally, but I forgot that I had a right to a crayon and paper until Feb 6th. That afternoon, I simply walked away from my seclusion room. I had had enough of them saying it was “merely a side room” not a seclusion room, then preventing me bodily from leaving it. So when I could do so without someone actually wanting to fight me, I walked away, and proceeded to enter the unit and walk down the hall to the end and look out the window, I took a deep breath, heard THEM behind me, and sauntered back to the proper end of the hall, the “lost end” where they kept anyone from seeing me or knowing what they were doing to me. Once I got there, they descended on me, the horde of the goon squad, some staff I knew, but most I did not. I did not bother to look at who was doing what to me. I simply lay passively on the bed, and put my arms out so they could do what I knew they would do. Tightly, they shackled my wrists out past my hips so there was no play in the restraints and I could not turn on my side or do anything but lie stiffly on my back. At the same time, others jerked my feet apart and just as tightly shackled my ankles to the lower corners of bed. Then came the coup de grace. They pinioned me on my side somehow, pulled down my pants, and injected me with three drugs: Haldol 5mg, Ativan 2mg, and Benadryl 50mg. Why, except as punishment I do not know. because I had, just a half hour before, been doped up on involuntary Zyprexa 10mg.

 

But of course it was punishment. The very fact that they told me it was “not punishment” but “what your behavior brings on every time, Pamela” only proves my point. At first and usually they only said, it was because I “didn’t follow directions” so if they were not punishing me, what were they doing? They most certainly were not following Centers for Medicare and Medicaid regulations for the use of Restraints and Seclusion only in cases where a person is in imminent danger or harming self or others! Indeed, the best they could do, when I protested, passively, saying just those words, was to respond, “You are not safe” as if that proved somehow that I was in danger or posed any imminent threat to the safety of anyone.

 

No, I did not. I didn’t threaten or harm anyone. I merely walked the length of the hall and looked out the window and then went back to my solitary confinement. But it was enough to trigger their retaliation, and that started at 1pm. I was not released, not even to use the bathroom or eat supper, no never even was a single hand freed to permit me to eat supper — until 7pm.

 

THEN, at 8:30pm, I became upset and frustrated because — well, I do not know now why, but I “threw a half a graham cracker at the wall” as I recorded later. And the goon squad descended on this dangerous patient again, not only with the strait jacket of four point restraints, but with the same 3 drug IM-in-the-ass cocktail.

 

This time, however, passive as I was as they trussed me up — and I said only, “For shame, for shame. You ought to be ashamed of yourselves, doing this to me…” — passive as I was, allowing them to seize my limbs and tightly shackle me yet again in truth I dared not resist, as that would only have justified their violence, and i already had my share of bruises. Bur I had come to my limit of the abuse i would silently tolerate. They could restrain and seclude me but they had up till now only silenced me in restraints because iu wanted to earn my way free quickly. THis time I didn’t give a damn. It was nearly nine o clock and no one knew what they had done to me. Everyone was getting their bedtime meds and going to bed without any understanding of what was going on. I was a stranger to most people on the unit, who had no idea I even existed. THAT was a situation that had to change. NOW.

 

After they trooped out of the room, stationing a 1:1 sitter at the door as usual, I stopped my merely silent and passive resistance and started to scream. I wanted to be heard. I wanted to scare people. I wanted them to wonder, Who is that person,. and what in god’s name are they doing to her? Are they torturing her? And I wanted them to ask questions of the staff that the staff could not answer. I screamed and I screams in desolation and despair, feeling like my life was at an end. The plan they had set up for me was impossible for me to live up to. In nearly 10 days I had not even earned my way to a pencil and my journal. Only to restraints and more restraints. I saw no way out of the hospital. So I screamed, long blood-curdling, heart-wrenching screams that I assume did the job of scaring all, as eventually they closed my door, much to the disgruntlement of the sitter who was forced to come inside with me and was no longer free to socialize. But not for a while. I kept on screaming until my voice gave out and I felt asleep.

 

The next day the substitute doctor freed me, I dunno why or how, but she did. and I thank my lucky stars as the staff doctor was a sadist and never would have. I have a lot more to say, but for now I am hoping to hear from a sympathetic lawyer who will take on my case for some reason for some purpose…Unlikely to happen. despite my bruised body and joints that are so out of whack I cannot sit indian fashion or cross my legs. Why won’t they help me or respond? I didn’t die, so they won’t earn a lot of money from my case, nobody gives a damn about mental patient abuse…

 

You really know when you are a third class citizen when you only MIGHT be worth more to them dead than alive.

 

 

Body Bagged, 4-pointed, Secluded and Tortured — All in the name of Treatment?

 

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The above is are just some bruises of many I received during my month-long course of “psychiatric treatment” at the Hartford Hospital’s Institute of Living, on the unit called Donnelly 2 South. In  Connecticut, the Institute of Living, first known as the Retreat, and once quite famous as a posh sanatarium for the rich and famous though this is no longer true, was first made famous by  Clifford Beers, I believe, who wrote about similiar torture he underwent there just a hundred years ago in the book, A Mind That Found itself.
 

After burning my face with cigars and cigarettes, I spent the last month in Connecticut’s well-known Institute of Living (yeah the dangerous 6th month was JANUARY not February but nobody thought to check my math) being beaten up and trussed like a pig in four-point restraints almost daily for many many hours. Why did they deal me this sort of treatment? Why? Because “You do not follow directions”.

 

I DID NOT FOLLOW DIRECTIONS so they beat me up and tied me, shackled me with leather and metal cuffs  to a bed for dozens upon dozens of hours.! Get that? I was disobedient, so they shackled me to a bed as an excuse for treatment!

 

After this experience, I LOST ALL FAITH in the ability of any institution to do anyone any good who has a mental illness or sickness of the mind, or any emotional disorder or whatever you wish to call it. I GIVE UP! I will kill myself if anyone ever tries to send me back to such a cesspit of a place. I do not care if it is appointed like the Taj Mahal. NO ONE who works there is uncontaminated by the evil infecting such places and they are ALL EVIL EVERY SINGLE ONE. I have NEVER been to a hospital where the people are kind and well meaning and where the treatment is actually kind and decent. Once in a  while a single person, such as the Middlesex Hospital occupational therapist  Christobelle Payne, may stand out in memory as being a rare human being of warmth and dignity and  caring, but otherwise, they all to a one fail the test of being decent human specimens and all fail royally to be even normally humanly responsive to suffering persons. They are in it for the money and a cushy job, and don’t you forget it if you go into a psycho hospital, DO not expect to get well there. Expect PILLS, and directions (ie ORDERS) that you HAVE To follow or ELSE.

 

Get out of there as quickly as possible, because your life depends on it. I am serious. DO NOT LINGER expecting care and treatment or to feel better no matter how helpful it might want to seem.

 

Furthermore. if you are a young person, do not listen to the sweet seductive advice that some may give you that you woul do well to go for “disability” and social security payments. THAT Is a load of total crapola and the worst thing anyone could tell anyone under the age of 50. I am so angry and broken at the moment that I cannot speak more. But if I can later on, I will say more to explain. At the moment, I have to attend to too many PHYSICAL bruises and to find a way back to sanity on my own, havin been driven to the brink of near extinction by one of the best known hospitals in this state. At the moment I am both rigid with rage and so confused and broken that I scarcely know how to continue, or whether I even want to. Why bother? Why bother? How can people be such  monsters, and in such monstrously powerful places and ways. I hurt so deeply and feel I will never trust an single person ever again when they say, Come let us help you. You need our help.  YOUR help? Like being raped, I need your F—ing help!

 

GO jump in a lake of snot is what I should say to all of you so called helpers. I’d rather die. Go F— yourself.