A mentor of mine, my NYC psychologists’ union president Dr. Lenny Davidman, contacted me yesterday and asked me to clarify what I meant in a tweet I had written earlier that day, in which I mentioned the influence of some ‘very stupid white people’ on what has happened in Kings County Hospital’s psychiatry department over the past several years. Dr. Davidman’s request led me to the conclusion that this is a good time – now that I have some safe distance from Kings County Hospital and my experiences there – to explain exactly what I experienced there, and why it was – and remains – so troubling to me.
I will begin by describing what I witnessed yesterday morning on my way to work, which triggered my (yes, traumatic) memories about Kings County, and I will then do my best to paint a brief but informative picture of what I witnessed during my two years working there as a clinical psychologist on an inpatient psychiatric unit – two years which coincided with the final two years of a 9-year investigation and transformation process led by the U.S. Department of Justice (DOJ).
On my way to work yesterday, I was walking on the train platform when I heard a very loud, hideous squeal, and turned to see that it had been emitted by a very young boy, who appeared to be of elementary-school age, who was throwing a tantrum and asserting that the tall, athletic woman who was with him needed to let him do something he wanted to do. I saw that she immediately cooperated with his tantrum, and I moved down the platform hoping to get as far away from this nonsense as I could. However, when the train pulled up, the young dictator decided the pair would advance towards me and enter the same car I was about to enter – oh lucky me. The young boy immediately charged to an empty spot on a bench beneath a window, climbed onto the seat on his knees, and stared out the window as his servant moved near him with watchful waiting, at the ready to satisfy any further requests. Fortunately he seemed happy that he was able to get a seat where he could look out the window, and I was happy that I was transferring to a different train at the next station. Before I got off the train, I noticed the woman making some brief eye contact with me and other onlookers. Her expression seemed to say, oh you know how it is, we have to give kids whatever they want, yes it’s frustrating sometimes, but that’s just how kids are, and it’s how we in fact need to respond to them.
One thing I haven’t mentioned yet is that yes, this boy and his caregiver were white. I have lived in NYC for over 18 years now, and the scene I witnessed yesterday morning is one I have witnessed many, many times over. I remember one time I was sitting on a train car filled mostly with people of color, except for me and two parents with an extremely unruly child. The parents were doing everything they could to help the child to calm down and stop screaming and throwing its ear-destroying tantrum, offering it this, offering it that. A cookie? A toy? Sit on Dad’s lap? Sit on Mom’s lap? This? That? Something? Anything? They were trying everything they possibly could, all with no success. The rest of us sitting on the train remained very quiet, but we all began to make eye contact with one another, rolling our eyes a bit and wondering when this torture would end. Finally the young family got off the car, and immediately several of my fellow passengers, all of whom had been completely silent up until that moment, opened up into a very lively conversation about what we had all just witnessed. The sentiment we all shared is that there are in fact a fair number of very stupid parents in this world who believe that it is always, under any condition whatsoever, wrong to set limits with a child. A parent is only supposed to give a child what it wants, these ineffective parents seem to believe. Discipline is a thing of the past, and we can’t set limits because that might stunt my child’s development, it might hurt the self-esteem of my little precious one. Well, after we survivors of that outburst on the train got out our frustration, we all had a good laugh about what we had experienced when we were growing up. One man of color said, all my Mother had to do was give me a look, and just from that look alone, I knew it was time for me to stop whatever nonsense I was causing and get my act together. We all laughed and agreed, because we all had had parents who had the sense to set limits with us. They cared enough about us to truly contain our emotions and our behavior. When parents refuse to set limits with their children, what they are communicating is: I refuse to contain you, and to make sure you feel safe and are safe. I refuse to prevent you from doing harm to yourself and/or others. I refuse to contain you while your frontal lobe is still developing, while you are still developing as a human being who needs to learn how to interact effectively with others. The truth, of course, is that parents do in fact need to contain their children, to set limits and keep children safe while their self-discipline and executive functioning (of the brain) are still in development.
I don’t know why exactly it almost always seems to be white parents who are publicly embracing this ‘I refuse to contain my child’ philosophy. I will leave it to the sociologists and other social scientists to figure this out. I suspect historians may also have some good insights about how this philosophy has developed. Whatever the cause, we need to begin talking about it and doing something about it. The ultimate victims of this neglect are, of course, the children who never get to have the experience of being contained. They are never happy, they move from one miserable tantrum to the next, always searching for satisfaction but never actually achieving it, because in fact they do not feel safe in this world.
So now let me explain how this relates to what I experienced during my two years (2015-2017) at Kings County Hospital. I actually also completed my one-year internship at Kings County a few years prior, in 2009, at the very time when the DOJ investigation and transformation was beginning. A lot of people think that the tragic death of Esmin Green was the event that led to DOJ’s involvement, but in fact there was already a lawsuit pending, based on reports that some patients had experienced violent abuse at the hands of the hospital police (HP), and that overall the psychiatric facility was a very dangerous and unsafe place. All of this was true, but what I find disturbing is that people in power who discuss the situation almost always seem to place the blame squarely on the shoulders of the frontline workers who were working in these horrible conditions. The truth is that the hospital has a very long history of being understaffed, which is the crime of politicians and hospital system officials, not the frontline workers who risk their very lives every day in an effort to help society’s most vulnerable. The blaming of frontline workers for the problems at Kings County reminds me a lot of what Vietnam veterans experienced when they returned from the war, expecting to be honored for the sacrifices they had made. Very stupid people spit on the Vietnam veterans (whether literally or metaphorically, the bottom line is that Vietnam veterans were hated on when they returned from their service) rather than on the corrupt politicians who placed them in that horrible situation. So if anyone wants to talk about problems at Kings County, I am going to be continually redirecting attention to those who are actually in a position of power to keep the hospital adequately staffed, and to provide the staff with adequate resources, including giving the staff the resources and the ability to set limits with patients who are violent and attempting to harm others.
So when DOJ started getting involved with Kings County in 2008, they sent a bunch of very stupid white people, attorneys, etc., most of whom I am pretty sure had never actually spent any substantial amount of time (probably zero in most cases) ON dangerous inpatient units. These attorneys, consultants, etc., were extremely idealistic, and were very much wedded to the very stupid idea that we mustn’t EVER do anything to set limits with a person who is actively violent. Oh no, they say, you mustn’t set limits, your job is to de-escalate the upset person. The way you do that, they say, is to give them everything they want, coddle them, just keep giving them things (very much like what I have witnessed some very stupid white people doing with their children on the NYC subway), talk to them with a nice, gentle, calm voice, what do you need dear? What do you want? Can I get you a cookie? Do you want to go out on the porch for a while? Tell me which staffperson you like the most, and I’ll let you have some special time with that person. What activities do you like? You want a teddy bear? Some time to play on the internet? Tell me what you want dear, anything, and it’s yours. So what would happen, when I was at Kings County, is we would be following this instruction to de-escalate an extremely violent, threatening patient, but all we were allowed to do was give the violent person what the violent person demanded. I remember this going on for a very long time, even for longer than an hour at times. The violent patient would be pacing the halls, meanwhile the staff would be frantically telling all the other patients to run into their rooms and hide to stay safe. The unit would go into complete shut-down during the violent patient’s ‘code’ (a ‘Code Orange’ was always called whenever one of these chaotic scenarios was about to begin). We had lots of great groups, therapy, activities, etc., on the schedule, but if a violent patient was ‘coding,’ that meant that everyone else had to run and hide somewhere safe while the unit went into shut-down mode, just to make sure nobody got hurt, most of all to make sure the violent person who was pacing the halls and scaring everyone – sometimes violently assaulting other patients and staff – got whatever they wanted and had eventually become fully de-escalated (i.e., worn out). DOJ began telling Kings County staff that they were not allowed to do ANYTHING to set limits with these violent patients. They didn’t want staff to use physical restraints, also they didn’t want the staff to use ‘chemical restraints’ – they didn’t want staff to medicate a violent, dangerous person, even if doing so would make the unit safer for everyone, including the violent person. These very stupid white people were opposed to setting limits of any nature, so patients and staff began to be assaulted left and right, and most of these assaults were not reported to hospital police, and many, many, many were covered up. When staff were injured, they were discouraged from reporting the assaults to the hospital police, and even if they did report the assaults, they were discouraged from pressing charges. One very stupid white person in particular, a supervising psychiatrist by the name of Dr. Michael Combs, would even intervene to prevent the hospital police from arresting someone, even when the victim had in fact pressed charges. This is exactly what ‘Dr.’ Combs did to me, in fact he did it in my presence, and he didn’t even ask the patient to acknowledge the crime committed against me, not even to apologize for having injured me. I do want to point out that there were many positive changes as a result of DOJ’s involvement. The hospital began hiring more psychologists and more creative arts therapists, in fact we had art therapists, music therapists, drama therapists, dance therapists, etc., and while the DOJ was conducting its investigation, the hospital was always fully staffed (of course, the moment DOJ left, hospital system administrators immediately engaged in a massive ‘slash and burn’ campaign that resulted in the hospital becoming horribly understaffed all over again, just like in the pre-DOJ days).
I would also like to point out that the Department of Psychology at Kings County is an amazing place, and had absolutely nothing to do with the countless coverups and the ongoing facilitating of violence in the hospital. I was the only psychologist who dared to speak out (NYC Health + Hospitals Central Office leadership has a history of being extremely condescending and hypocritically draconian), but the other psychologists always supported me in private and praised me for standing up for the rights and safety of patients and staff. Also, almost all of the inpatient frontline psychiatrists who worked with me were amazingly supportive. What frustrated all of us was that we were expected (by DOJ and DOJ-stroking supervisors, such as Michael Combs) to make it impossible for violent patients to ever experience any consequences for causing harm to others, and for committing crimes within the confines of the hospital. We all agreed that it was a good idea to remove the hospital police from the units and to replace them with behavioral health associates (BHAs), but this got taken way too far. The new idea was, ‘the hospital police are bad, so we can’t even allow them to arrest patients who commit violent crimes against other patients or staff.’ This, of course, was a very stupid idea that led to a countless number of violent assaults against many patients and staff. I am most disturbed by the patient-on-patient violence, as many of these assaults were completely unprovoked, and as far as I know, nobody ever helped the victims to file reports or press charges. It was a veritable bloodbath, and the ultimate victims were the assaulted patients who often didn’t even have the mental capacity to know that they even had any rights. If anyone reading this cares about the victims of these crimes as much as they care about the individuals who committed the crimes, they will demand an extremely thorough investigation of what actually happened at Kings County Hospital between 2008 and 2017 to the victims of the violent crimes, though I suspect that much of the information has already been effectively shredded.
I’m feeling overwhelmed just writing all of this, but I knew it would all come out of me eventually. Please bear with me while I share just a couple more observations (and take a break from reading this if you need to – take care of yourself).
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Okay, we’re back.
One thing that really disturbed me during my two years on the inpatient units was the fact that whenever one patient assaulted another patient, department of psychiatry administrators would always want to ‘resolve’ the situation by moving the victim to a different unit, to move the victim away from the aggressor. I always protested this, explaining that we needed to put the victim’s needs first. The victim had already become acquainted with the staff and patients on that person’s current unit, so to move a victim who had just been violently assaulted to another unit, where that person had to meet and become acquainted with a whole new group of people – while at the same time still recovering, physically and emotionally, from the sequelae of a traumatic, violent assault, just felt wrong on absolutely every level. Most of all, it was an affront to the rights and needs of the victim, and it reinforced the power and control of the aggressor. When a victim would get moved to a different unit (as was almost always the case), the aggressor would feel even more power, would realize he had effectively become the new ‘alpha’ of the unit, possessing even more power than the unit staff, and would begin to throw his weight around even more. Sometimes when I protested the practice of moving victims rather than aggressors, staff explained that they didn’t want to inflict a violent person on another unit, but that justification really is not justified, because it places the convenience of staff over the needs of the patients. We need to do a better job. We need to have more forensic units, more forensic hospitals, more forensic services (Kings County, of course, has none). We need to allow spiritual leaders to go into forensic facilities and to help the patients to reform, and we need to make the system better so that it actually helps people to reform, and teaches them how to make their lives better. We also need to protect psychiatric patients who are not violent from those who are violent. Sadly, most patients who end up at Kings County are there either because they are poor or because they have no family. There really is no one to stand up for them, and the idiotic DOJ came in and empowered violent patients to cause even more harm against these highly vulnerable individuals. I remain utterly outraged over this, and will never be able to forgive the DOJ until there has been a full investigation, until the harms to the victims have been rectified, and until the hospital changes its orientation to protecting victims rather than protecting aggressors.
The last thing I would like to say is that there is definitely a racial component to all of this. Most of the frontline staff at Kings County Hospital are people of color, and many of them are immigrants from other countries, who feel so grateful to have a job in the U.S. that they are absolutely frightened to ever make any waves or stand up for their own rights. When James Fanelli, an investigative reporter for the NY Daily News, contacted me last year to ask me about the violence that was happening at the hospital, I was frightened to speak to him, but agreed to do so because I believed it would help the countless victims of violent crimes within the hospital over the past several years. Of course, as a white male who is also a doctor, I have a certain amount of privilege such that there was less at stake for me (in comparison to most of the other frontline workers) to speak to the media about what I was witnessing at the hospital. Mr. Fanelli asked me to find other frontline workers who would be willing to speak with him, but every frontline worker I spoke to was utterly terrified to do so, even just to contact Mr. Fanelli anonymously from a payphone. My dear friend Ms. Allen, one of the most amazing mental health workers I have ever known, was bashed in the face by a male patient, and the hospital then covered it up and prevented the patient from being arrested. Ms. Allen is a woman of color and an immigrant from Jamaica, so department of psychiatry administrators thought they could get away with trampling over her rights and safety, but she proved them wrong when she decided to join me and speak out to Mr. Fanelli of the NY Daily News. She and I were the only two staff members in the entire Behavioral Health department who dared to speak out.
There’s a lot more I could tell, but for now I’ll just say that the Good Lord helped me to get the hell out of Kings County Hospital soon after Ms. Allen and I spoke up. Interestingly, my new job is with the NYC Family Justice Center, a walk-in center (there is one in every borough) that is actually designed entirely for the purpose of protecting, supporting, and standing up for victims. I work together with case workers, advocates, attorneys, police officers, the DA, and others to do everything we possibly can to protect victims of domestic violence, elder abuse, and sex trafficking, and to make sure they stay safe. This experience has helped me to realize that what Kings County Hospital really needs to do is to adopt a similar model of practice. Rather than trying to completely drive the hospital police out of the situation, they need to learn how to work in collaboration and cooperation with the hospital police, the DA, and other key players in the mental health system and the criminal reform system. They need to place the rights and needs of victims above those of aggressors. I believe God sent me to the NYC Family Justice Center, from Kings County Hospital, to show me a vision of how to structure an organization that by its very design puts victims first, which provides rehabilitation for aggressors, but not at the cost of the rights and safety of victims. Aside from the problems I have described, Kings County Hospital is actually an amazingly wonderful psychiatric facility with so much potential to make the world a better place for the people it serves. However, for that to happen we need to start having conversations about how to keep victims safe, how to protect their rights and assure they have due process. Also, we need to start having conversations about how to help aggressors to reform through the use of limit-setting and the provision of consequences for violent behavior, to help aggressors learn how to navigate this world in a safe manner. And we need to get our spiritual leaders more involved in helping them to reform. We cannot do this alone.
This is my prayer, and I say it with the entirety of my heart and being.
To everyone who is working to make Kings County Hospital a better, safer place, I send my love, my prayers, and all the hope my heart contains. I know we can work together to make this world a better place. Never stop hoping, because although the road is tough, we have each other, and when we work together, we can make miracles happen.
Most truly yours always,
Ben G. Adams, PhD, Clinical Psychologist
February 28, 2018