These are important points about trauma to remember: how it is experienced by the individual matters more than the nature of the event. I would also like to point out to those who think that doctors and nurses cannot cause PTSD, trauma inflicted by caregivers, as seen above, tends to be the most severe, esp when repeated. So when psychiatric caregivers repeatedly seclude and restrain patients in abusive and brutal fashion, as they do and did me, trauma results inevitably in those who are prone to it…
I had a long talk with my psychiatrist yesterday about my ongoing anger on this issue,and i said to her that it was easier for a Mengele twin to forgive the Nazis than for me to forgive Michael Balkunas, MD because the whole world acknowledged (or most of it) the heinous deeds of Hitler and Mengele, and grieved for the slaughtered millions in WWII…they acknowledge that terrible wrongs were done. But who ever acknowledges that wrongs were done to me, or to other mental patients? NO ONE! Entire nations apologize to the Jews and even the violated catholic children get an apology from Pope Francis but american mental patients just get more forced Haldol shots and silencing! Am I angry, yes! And hurt and my heart races and i get tearful every time i even go to that place where i tHink about Manchester or Middlesex or Hallbrook, or st raphaels or Yale or new Britain General or so many other bad bad places i have been…but i am leaving Connecticut. I have to. i will be moving to Vermont on November first, whether they really want me, destitute or not, because i believe they have a kinder system towards both the people and the environment up there. And finally, as Rainer Maria Rilke’s wonderful poem “The Archaic torso of Apollo” ends, “Du must dein leben andern…” Or you must change your life….and that is what i am doing, in huge style. Changing everything. Ending one life and starting a brand new one in another place i have only once spent 6 weeks…i know no one there except two people i met there this summer. But i can do it. I survived rape and poverty and near murder. I can survive anything.
What do therapists mean when we talk about trauma?
One definition I like states that “psychological trauma is the unique individual experience of an event or enduring conditions in which: “The individual’s ability to integrate his/her emotional experience is overwhelmed or the individual experiences (subjectively) a threat to life, bodily integrity, or sanity.” (Pearlman & Saakvitne, 1995, p. 60)
The important part of this definition in my practice is the emphasis on “unique individual experience”. You get to define which experiences are traumatic for you, whether or not it would impact others in the same manner. It’s not the objective facts that determine whether an event is traumatic, but your own emotional experience of the event.
Here is what I wrote in response to this amazing post on Taking the Mask Off. A difficult post to read but so very worthwhile: Dear CP,
I am crying as I write this, and trying not to wipe away my tears, because other people always hand me kleenex saying, “Don’t cry, don’t cry!” when sometimes the world has sad stories to tell and crying is a good good good way to deal with this and their kleenex is just a way of telling me of THEIR discomfort with my feelings.
But I cry not only out of sadness but because you understood that 12 year old daughter’s undying loyalty and her love for her mother, and you also “got” her drunken abused mother so incredibly well. This has made you, Cortland, such an incredibly empathetic person, I feel honored and a bit safer in the world just knowing you are here in it with me.
Thank you for feeling safe enough to share this story with us. You amaze me, constantly. I was unable to read this for the longest time, as it brought up difficult feelings but I am so very glad I did…It is an astonishing and uplifting story fundamentally, largely because of your attitude and what you learned from it all. AND because of what you insist on teaching us from it.
Right on! and WRITE on, and fight the good fight because that is all any of us can do. And thank you Cortland, for being you. You give me hope beyond hope that there is good in the world.
Written months after my 4-week admission to the psychiatric unit, W-1, at New Britain General Hospital/ Hospital of Central Connecticut, in 2014 where I was “treated” and abused by Dr. Michael Edward Balkunas, MD
Nine days after your worst hospital stay ever
you are still wearing the shades
that protect others from you
though no one else believes they are in danger
Those staff however wrote you up
as “assaultive” and dangerous to self
and others. But they didn’t mean it the way
you do now and their description of your
behavior was neither accurate nor truthful
Often they lied, as liars do,
just for the sake of convenience.
Now you are a week away from meeting new “cousins”
who await your vacation in northeastern Vermont,
a place magically named the Kingdom
and the recuperation your mind-body badly needs.
Still unable to let go, you perseverate over
the half-nelson grip of sadistic guards
bent on eliciting pain.
What happened to the nurses’
their concern for “the dignity, worth,
and uniqueness of every individual”,
or their “primary commitment
to the patient?”
When the guards forcibly stripped
then four-pointed you to an bare mattress
they were just replaying their favorite rape
yanking each limb wide
to expose, degrade, humiliate.
Never mind the nurses’ vow to protect
the vulnerable. The official hands-off policy
protected only their own asses.
So how do Truth and Forgiveness Programs proceed
when so many refuse to acknowledge wrong?
The hospital broke every humane rule;
they only stopped short of murder
because you submitted,
nick of time. Yet they had the last word:
stuffing your screams
when they muted the intercom
and slammed the door between you
and the mandatory one-to-one observer.
No one ever is there to bear witness, is there?
That point has always been the point,
from Daddy to doctors.
and all the hairdressers and nurses in between.
They’ve made a religion of secrecy
and no one wants to know
what they don’t want to know.
Call it “our family’s business,”
call it “a private cut and shampoo,”
or just call it, discreetly, “treatment”–
but they can always do what they want to, to you. .
Some amazing musings on Borderline Personality “disorder” by taking the mask off. Beautiful post. I will comment later.
Later: one comment i did want to make is this: so far as i know, and despite current claims, RW never claimed to suffer from anything other than depression and drug and alcohol addiction. He never to my knowledge claimed to be “bipolar.” Now, if one of his drugs of choice in self-medicating his depression was cocaine, and i am not saying i know this to be a fact, only supposition, then that RW may have been using also Alcohol to reduce the manic frenetic highs of cocaine, not that he naturally experienced highs and lows.
But now certain website want to place Williams under their bipolar umbrella.
I frankly find it troubling this push to subsume everyone with depression under t he bipolar blanket.
If it produced fewer people suffering from longterm disability and mental illness as a result, then i would cheer it. But in point of fact, research has shown that even in strictly diagnosed Bipolar 1 in which mania, naturally has occurred, treatment with lithium has not in fact served people as well as they claim. In decades before lithium came on the market, before they claimed to be able to “treat” manic-deproession, sufferers largely were rarely seen in the large state hospitals and usually only on a temporary basis. They were not longterm or chronic patients. Usually they got better and if they occasionally suffered downs again, the manic episodes might never be seen again after the initial one. The point being that bipolar susceptibility was not the chronic and terribly disabling illness that it has suddenly become, and i blame the medications for that development. That and the huge expansion of the diagnosis into BipolarII so that everyone with depression, even bereavement, is now labelled bipolar with several devastating consequences.
one is that the person is told they have a chronic, severe incurable mental illness for which they must take meds the rest of their lives, which will end up being a vicious cycle. That mentality produces enormous disability, lifelong. Two is that it ruins lives that might have been productive had the verdict been less dire and the treatment less dire too. Instead of telling someone who is depressed that their occasionally periods of cheer or even anger are appropriate, doctors see them as symptoms of this new entity bipolar II and use new useless drugs on them, including antipsychotics, with terrible side effects and psychological effects that are even worse. I have literally never seen anyone once diagnosed with Bipolar II get better unless they rejected the dx entirely and left the labeling System altogether…how can anyone escape it otherwiThey want you to believe that your moods are an illnesss rather than a healthy way to fight back against depression, as if it is abnormal to feel anything other than sadness! It is, in a word Meshugas of the highest order.
Re “When Cell Door Opens, Tough Tactics and Risk” (“Locked In” series, front page, July 29):
The events leading to Charles Jason Toll’s death highlight the dangers of prison procedures, especially for vulnerable inmates who suffer from mental illness. Particularly concerning is Mr. Toll’s solitary confinement, a disciplinary technique repeatedly identified as ineffective and counterproductive, and even as torture.
The Justice Department has found that solitary confinement of mentally ill people violates their rights under the Eighth Amendment and the Americans With Disabilities Act.
Solitary confinement worsens psychological symptoms and can trigger outbursts tied to the person’s feelings of hopelessness and loss of a sense of self through extreme social isolation and sensory deprivation.
Providing mentally ill people with appropriate and compassionate mental health care, including integration of psychiatric, psychological and psychoanalytically oriented treatments, is crucial in restoring a person’s identity, alleviating feelings of loss and distress and reducing violence.
Mr. Toll’s solitary confinement, suffering and death were avoidable, and again show that the mentally ill are more likely victims of violence, not the perpetrators.
Middletown, Conn., July 30, 2014
The writer is a psychiatrist.
When I was a patient in May and June 2014 at New Britain’s Hospital of Central Connecticut, Dr Michael Edward Balkunas regularly imprisoned me in a horrific seclusion cell, without a single amenity but a concrete built-in bed and rubberized mattress, for nothing more than making too much noise for the approved hospital milieu. In fact, several nurses took it upon themselves, with Dr Balkunas approval, to do the same. This became literally routine. I was NOT, as is required by the Centers for Medicare and Medicaid, in IMMINENT danger of causing severe harm to myself or others. No, I was loud, disruptive and uncooperative, and I was rude. Period.
My first reaction when the double doors locked behind me was immediately to start screaming, at the top of my lungs, from the base of my lungs. But screaming brought no one. Okay, they did soon come in at me with three IM injections, but they came back every time with IM injections anyway, because as I took to calling it, these were part of the drill, they were “punishment injections.” I was pushed onto my stomach and shoved into the mattress so I couldn’t breathe and injected whether I liked it or not. I tried to say, “STOP! I will take the injections, just don’t hold me down.”
But sometimes they didn’t listen to me, and held me down anyway, and I got scared that they would kill me, because it didn’t matter that I didn’t struggle. There were four of them to the one of me, and they expected me to fight and so they forced my face into the mattress and held me tight, hard, and with all their weight….until I felt my breath go out of me. Did they have any idea that I was NOT struggling, that I felt I was going to die? Did they have any idea that they were killing me?
I don’t know. I don’t know. All I know is that I felt in mortal danger when they wouldn’t let me just accept the injections on my own, in my arm, but insisted on giving them to me by force in the buttocks, even when I said I would take them voluntarily.
Then they would leave and lock the double doors. And I would scream, and NO ONE would respond, even though I eventually learned that they could not only hear me through the intercom hidden somewhere in the ceiling, they could also talk to me. They wouldn’t but they could have. When screaming brought no one, I would strip and urinate on the floor, and I would defecate too as much as i could, and smear everything on the walls and floor. I would even eat it and paint it on my body. I didn’t care, I DIDN’T CARE! I just wanted someone to come in and help me.
Several times I washed and colored my hair with urine, thoroughly. But no one came back for hours. The urine, which completely soaked my hair, had time to dry completely. Not that they cared or noticed. If they had, they said nothing. It was nothing to them. Only Barbara RN asked me what was in my hair, and insisted that she wash it out when finally they released me. I went with her to the shower-tub room and allowed her to do so, but only one other person was kind enough to notice and do that. Everyone else just released me and expected me to somehow be reformed and “better” after my hours of punishment.
Of course that wasn’t the case. I got worse, much worse. I started defecating in my bedroom, at any hour,for any reason, any time I was frustrated or angry. They decided I had “borderline personality disorder,” that I was simply manipulating them. They failed to see that they had traumatized and broken me. They failed to see their continuing role in my behaviors…which were getting worse and worse the more they punished me. Every time they secluded me, or four-pointed me, I regressed more.
Dr Balkunas actually decided to commit me to the State Hospital claiming it would help me “get better.” But really he was just in punishment mode. You could tell, because he wasn’t using any of the methods that you are supposed to use for REAL borderline patients….If he really believed I was BPD he wouldn’t have kept at it. But he knew from my brother, a psychiatrist too, and my own psychiatrist, that I do not have BPD, so that was bogus and just an excuse to torture me. He didn’t really think I had BPD. He just needed an excuse to use solitary confinement and he knew that schizophrenia was NOT a good reason. A very BAD reason in fact, so he invented a secondary diagnosis to use. But the thing is, there are other therapies you are supposed to use in BPD, and he never bothered to treat me with anything but punishment and then threw up his hands and said, Well, the antipsychotic drugs take time to work, so you will go to the SH until they do.
Bastard! He gave up on me without even trying to help…so-called saintly doctor. Just a bastard! Because torture doesn’t work to make me better, he decides that I am the one at fault????? Well GO FUCK HIM UP THE ASS WITH A BROKEN GLASS JAR!
1. CLOSE YOUR MOUTH AND BREATHE THROUGH YOUR NOSE.
This will make you realize you CAN breathe just fine and immediately stop the panic.
2. WHILE BREATHING THROUGH YOUR NOSE, gently try to push the food item back up into your mouth, or swallow it if you can.
I figured this out while living alone. I would panic when I felt myself choking. It works like a miracle, because it is usually a spasm in the upper throat, near your mouth, and not a closed off pharynx that causes coking sensationss. You just have to understand that you CAN still breathe through your nose and that will end the panic. Once the panicky feelings are over, everything is easier to deal with and you can usually spit out the food or even find a way to swallow it. But at least you realize that you are notimminently going to die, which is a good thing to know.
Hope this advice helps someone. If it does, I would love some feedback. I have offered it to friends, and they have loved it, found it useful too, so I know it works.
Actually I “deserved” four-point restraints. I was “violent.”
But I want to explain what “deserving” restraints and being “violent” at New Britain General Hospital (Hospital of Central Connecticut) means in 2014.
I also want to tell you something else even more important: In Connecticut, the staff at almost every psychiatric unit or hospital will insist that “we only use seclusion and restraints when essential, when a patient is absolutely out of control and extremely violent, and cannot be controlled in any other way.”
Trust me, I know, because they have said this to me.
But what you need to know is that they are NOT talking about some 300 pound man hopped up on PCP, waving a machete. For one thing, that person, whom I believe to be largely mythical at least in ordinary psych units, or if real now largely confined to correctional and law enforcement settings, the person they are talking about, the rule, not the exception to the rule of the “extremely violent” person whom they claim must be restrained due to lack of any other method of control, is, to put it grammatically correctly, I.
And let me tell you about me. I will turn 62 years of age in November. I am 5 feet 3 inches tall, weigh, maybe 110 pounds on a good day, and have been consistently described as “poorly muscled.” I am also unable to use my left arm for much of anything, due to injuries sustained at the Institute of Living in 2013, including a small tear in my rotator cuff and possibly more than that– a fact the HOCC nurses/security guards knew and used to their advantage when subduing me. I also want you to know that I am a decades-long vegetarian on the principle of non-violence — to people as well as to animals. I have opposed the death penalty since I was a nine year old child (when I first learned of it) and do not even believe in the principle of prisons, or in treating our convicted “criminals” the way we do now.
Yet in every single hospital I have been in since 2000, and of course for years before then (“before they knew better”) I have been brutally secluded and restrained multiple times as “OOC” — out of control — and “violent.” In addition to either physically holding me down by brute force, one person to each limb and one to my torso (this was at the only 2 hospitals that did not actually resort to mechanical four-point restraints– compared to the dozen others that did), they would routinely inject me with one to three drugs as chemical restraints.
I am the rule, not the exception to it, of their supposedly “extremely violent mental patient” who is so OOC — out of control — that Connecticut hospitals refuse to eliminate the use of restraints and seclusion, because they “might need them.” I am the typical example of the person they claim they absolutely must have the right to resort to violence against, for their own safety and mine.
Okay, so am I truly violent? What did I do to deserve their brutality? Or should we say, their “protective measures?” Well, at HOCC, in the Emergency Department, this is what happened, and I kid you not: I came in by ambulance, involuntarily, in the sense that I did not want to go but was brought in by EMTs and given the “either the easy way or the hard way” choice by police. But I did not resist it or fight. I was not restrained in the ambulance. in fact, I was mute and merely handed them my med sheet and my detailed Advanced Directive, on the first 2 pages of which is the important information about my trauma history and the critical need to know points about how to deal with me.
When I arrived I was quickly shunted to the psychiatric crisis section and into a curtained off cubicle. No one took my cell phone from me, or the single book of my artwork that I had managed to bring with me. So I texted everyone I could for as long as I could. For a while I tried to obtain a crayon to communicate with, eventually and in desperation, writing with ketchup on the outer carton of my dinner container, begging for something to write with. Instead of helping me out, the head ER nurse penned me a note saying that I would not get anything to write with, that either I spoke out loud or she would not listen to me. How very odd and evil that she wrote this to me! She didn’t speak to me, she wrote it, as if I were deaf, even while saying that she knew I could speak and would not talk with me unless I did so… The idiocy of that act just sends sparks of rage through my brain even now. She later spied my art book next to me on the gurney, and suddenly rushed me, snatched it out from under my thigh and raced away with it, holding it triumphantly as if she had won a prize. I was incensed. Why hadn’t she just asked me for it? And how did I know what she was going to do with it? Would she keep it safe and sound? Actually, though, I mostly just reacted instinctively: Someone had stolen the only thing I had of my own in my possession, and she had simply snatched it away from me, without a word or even a polite request. So I did as anyone would do, I think. I raced up behind her and snatched it back! Well, that was a mistake. That was bad, that was bad bad bad. I heard people groan and swear. I was grabbed from behind by two security guards and the book was wrenched from me again.
Remember, I was mute so I couldn’t say anything, but I tried to resist, tried to gesture that the book was mine and she had no right too take it from me. Instead of explaining that she would protect it and take care of my things, people started talking about how I had attacked the nurse, had assaulted her…She told them to put me in seclusion. The guards dragged me, resisting in panic, towards this hidden room, and I heard another nurse warn them of my medical history with a torn left rotator cuff. Hearing this, the guard on my left side, grabbed my shoulder and wrenched it higher until I let out a blood curdling scream, wordless but vocal. “Aha! I thought you could make sounds!” he said in triumph, wrenching me again until I sobbed in agony. Then they dumped me in the seclusion room, with only a hospital johnnie on me, and locked the door behind them.
Even though I had no words to speak my rage and panic, I screamed and screamed. They came through the door with needles, held me down and injected me. Then, when in a rage reaction, I disrobed, they decided to four-point restrain me. I heard a guard say, “we really have no reason to restrain her, you know.” But the other said, “It doesn’t matter, we will find a reason.” So they did . Terrified, I did not resist, because they held me down by the left shoulder causing me so much pain I was afraid they would hurt me permanently. I also hoped upon hope that if I didn’t resist, they would let me out quickly. Believe me, I had been through this routine enough to know what to try to do to minimize the consequences and the damage…
Fast forward to my being sent to the psych unit, about which I no longer had any choice, being labelled violent now and OOC as well as mute and schizophrenic (I hate that word but they used it). When the doctor who admitted me, Dr. Michael Balkunas, came to see me the next day, I was still mute. He asked me how I was and I gestured my need for a writing implement to answer his questions. He coldly told me that he would not speak with me if I would not talk out loud. Then he got up and walked out the door, with nothing more to say. I was by then so upset and outraged that I got up off the bed, which was the only furniture in the room, and slammed the door after him. I meant only to make a noise to express my frustration, but unfortunately it caught him in the shoulder. This was not intentional, not that I recall, though I confess I was so enraged by his dismissal of me, especially after the violence inflicted on me not once but twice the night before in the ER on his orders, that it is possible I wanted the door to make contact with him. What I know is that I most certainly did not intend to injure him. I only wanted him to know, before he walked away from me, that I was angry and “speaking” to him the only way I could. Dr. Balkunas’s reaction was itself swift and violent in the extreme, and extremely personal. Enraged, his face beet-red, he bellowed at the nurses to order guards to force me into “Seclusion! Seclusion! Restraints! Restraints!”
Before I could do anything or even assent to walk there, I was bodily dragged down the hall by my injured shoulder, to one of the most horrifying seclusion suites I have ever seen. A set of two cells, each lockable from the outside, completely barren and cold except for a concrete bed set into the concrete wall, with a plastic mattress on it. Nothing else. No commode, no bed pan, nothing but two obvious cameras in the ceiling, but no obvious way for me to communicate with anyone. They locked me in, locked the second door a room away, so I was thoroughly alone and soundproofed from the rest of the unit, and walked away. I panicked immediately, and urinated on the floor in my panic. I took off my clothes. I screamed — wanting someone to talk to me, I wanted warm dry clothing to wear, but there was no response. I screamed and screamed. Nothing. Not a word. I did not even understand at that time that there was an intercom they could hear me through. I thought I was completely alone and abandoned, but for the eye of the camera. So I did what I had to. I KNEW what would happen, I knew this because it was SOP. But I was freezing in there, with the A/C on full bore and at 110 pounds and a history of frost bite I cannot tolerate being cold. I also had NO inkling as to how long they would keep me there, one hour or sixteen. All I knew was that I could not tolerate the isolation, one, and I would not survive the freezing temperature, two.
So I took the urine-wet johnnie I had taken off and I rolled it into a rope and tied it around my neck. I pulled on it as if to strangle myself. It was useless of course, because I couldn’t keep pulling it without letting go and then I would breathe. And I didn’t want to die, I just wanted it to LOOK as if I were strangling myself so someone would come in and I could explain that I was COLD! Well, finally the intercom crackled to life and someone said, “Pamela, take that away from your neck now.” I gestured something that clearly indicated, “I’m freezing cold!” The voice spoke again, “If you don’t remove that from your neck, we will restrain you.” I answered silently but in clear gestures, “I need something warm to wear!” Well, this was a battle I was destined to lose, of course. And eventually but not so quickly as to indicate that they were seriously concerned about my safety, guards and nurses entered the room, along with a gurney, and they did as they had threatened, injuring me in the process. They grabbed me and hoisted me onto the gurney and locked me into leather restraint cuffs, in a painful and illegal spread-eagle position, despite my groans of pain and protest, then they refused even to cover me with a blanket. Someone threw a small towel over my lower torso and that was all. They they positioned an aide at the door and trooped out. I screamed my lungs out, and gestured my desperate need for water and warmth, but the aide simply ignored me, saying she wasn’t permitted to talk to me, and couldn’t get me what I needed. That was how violent I was. And that is how the most violent patients are treated and why they MUST be restrained, for their own safety and the safety of others…Right? NOT! ALL the other times I was secluded it was because i was disturbing the peace of the unit. I was loud and complaining, or simply “agitated” because i walked the halls too much.
That was it. That is the rule not the exception, and if you read my posts about my incarceration at the Hartford Hospital Institute of Living in the winter of 2013 you will get a similar picture. I am not the 300 pound crazed man on PCP wielding a weapon, no, I am a small, elderly woman who is non-compliant with the unit milieu and wants only to be warm…that is about it. But each and every hospital claimed that I had to be restrained, that they had NO alternative, that I was so violent that they had no choice, even though it often took only one or two people to do so, because I didn’t resist or say a word, just lay there while they pinioned me to the bed. Now you tell me that restraints and seclusion are necessary ‘modalities of treatment” that cannot be done away with because they might be needed in an emergency. Emergency schmergency. I am that emergency and they were and are NEVER needed, EVER.