The pattern of therapy: Sedation and brutal neglect

Part II

WAYMART, Pa. – When the cornerstone was laid for the construction of Farview Hospital on July 24, 1909, Dr. Charles G. Wagner, superintendent of the State Hospital for the Insane at Binghamton, N.Y., had this comment:

"If there were places of this kind available there would be no longer any excuse for the deplorable practices of placing the insane even temporarily in common jails where, often, regardless of sex or mental disturbance they are grossly ill-treated ... Concentrated effort on behalf of the individual patient will be the watchword of the future.

"Your wards will be well-ventilated apartments, lighted by electricity, heated by steam, and comfortably furnished, with carpeting on the floors, pictures on the walls and draperies at the windows, for all these things help to banish the idea of prison bars and to make an environment that tends to aid the recovery of the patient."

That isn't quite the way this worked out at Farview, Pennsylvania's hospital for the criminally insane. To most inmates – certainly to the former inmates, staff members and officials who talked to The Inquirer – prison, any prison, looks good after "hospitalization" at Farview.

Technically, of course, Farview is a hospital. But among inmates, guards and even administrators, both of Farview and other state institutions, Farview has another reputation – that of a concentration camp, brutally run by and for guards. By no stretch of the imagination, they say, is it a "hospital" or place for "care" or "therapy."

For example:

To treat its 354 "insane" inmates, Farview has not a single psychiatrist certified by the American Board of Psychiatry and Neurology.

It has only five physicians, and none of them is regularly in the hospital past normal working hours.

Particularly obstreperous patients have been "treated" by being stripped naked, handcuffed and in foot and then thrown into concrete cells without even a mat to sleep on. Sometimes, such "treatment" has lasted for years.

There are only eight psychologists at Farview, and not all of them have degrees in psychology. There are only about 30 registered nurses (until 1972, there was one) and only eight social workers (until 1969, there was one).

There are, however, 305 guards, or nearly one per inmate. They are men who are recruited – most of them decades ago – from the rural area around the hospital. They have had little or no medical training. They are called "psychiatric security aides."

Some patients at Farview have waited for decades before psychological evaluation. Then, more years passed between evaluation and the initiation of recommended treatment.

When "treatment" finally does come, it is limited to tranquilizing drug injections for those patients that guards do not want to deal with and some minimal occupational therapy (ceramics, leathercraft, art) for a very few privileged inmates.

None of this is the secret to state authorities responsible for Farview.

As The Inquirer pointed out yesterday, both the State Police and the state attorney general's office, through quiet investigations of their own, are aware of the truth about Farview. And nothing has been done.

The state Department of Public Welfare, of which Farview is a part, has been informed of conditions there by former administrators. And nothing has been done.

A committee of the state legislature has her testimony by a criminologist who told of the terror that former patients exhibit at the mention of Farview and of their relief at being transferred to another institution – any other institution. And nothing has been done.

The truth about Farview lies not just in the minds of those who have lived through their confinement there. It lies, in ample detail, and reports, surveys and investigations that have been filed away in the offices throughout Pennsylvania's state government.

1974 survey

One such survey, May 1974 by a "Utilization Review Committee" of Farview staff members, discovered, among other things, the patient who had been admitted to the hospital in 1930 had waited 26 years for his first psychological interview and test. It was another 13 years, for a total of 39 years, before he was given a diagnostic staff evaluation.

Another patient, admitted in 1944, waited 24 years for a diagnostic staff evaluation and 30 years for the beginning of formal treatment for his mental illness.

Another had waited more than seven years for his first diagnostic staff evaluation. At the time of the survey his formal treatment had not yet begun.

For many, the diagnostic staff evaluation might as well never have been made.

In one case, according to Dr. Michael McGuire, who was superintendent of Farview for seven months until he resigned in disgust and frustration in November 1974, the staff decided that the patient's mental condition had significantly improved and his transfer out of Farview was recommended. Dr. McGuire concurred, and directed that the patient be released.

Several days later, however, the patient was still in the hospital. Dr. McGuire said that he had checked the patient's file and discovered that Dr. Bernard J. Willis, the hospital's clinical director, had an effect countermanded his order by writing a report "that bore no resemblance to the actual condition of the patient, or recommendations of the staff in my own decision as superintendent."

'Humiliation'

Another former patient, Roberto Torres, now confined at the State correctional institution at Dallas Pa., recalled in a recent interview that a diagnostic staff evaluation was "simply a humiliation."

"The doctor asked me if I had performed sex with my mother or sister or brother, or whether I wanted to. Then he said he had heard that I had made sex with dogs. How could he say such things? I think he is the one that is crazy."

That is not the only humiliation recalled by patients sent to Farview for care and treatment.

Patients who have left Farview for other institutions recount instances in which they were required by guards to commit sodomy on other patients and to watch while patients submitted to sodomy with guards. Leon Ziegler, who spent eight years at Farview and was transferred to another hospital 18 months ago, estimates that 75 to 100 of Farview's 305 guards had sex with patients. (Ziegler was released from institutionalization early this year and declared sane. Currently, he is a truck driver in central Pennsylvania.)

Other patients recall having to help hold patients on the floor while a guard urinated on them or another patient defecated on them.

They recall being placed naked in the "peanut," a tiny room with a window in the ceiling – there's one on each ward – and having buckets of water thrown on them while the window was open in below-freezing weather.

In April 1973, Helene Wohlgemuth, at the time secretary of the State Department of Public Welfare, banned such cells as the peanut, along with cages and netting tied around some patients. And officials of Farview today say the peanuts are no longer in use.

However, in April 1974 – one year after the peanuts were banned – Farview inmate Michael Marrera, in a letter smuggled to Lt. Governor Ernest P. Klein, complained about his own recent detention in a peanut after he had balked at an order to get a haircut.

Marrera's 26-page letter to Kline, in which he referred to Farview as "God's forgotten world," vividly detailed other abuses in Farview, including brutality, racial slurs and illicit gambling. Klein mailed the letter back to Farview – to Dr. McGuire, at the time Farview's acting superintendent. Kline suggested that Marrera's letter "may be useful in his future treatment."

McGuire turned the matter over to Thomas Glacken, a Farview social worker, who responded in a handwritten note to McGuire that Marrera "does ramble on at length about the hospital not doing anything to help patients and in fact are (sic) actually hurting patients."

"I have to acknowledge," wrote Glacken, "there is some credibility to what he states."

No one recalls Farview more vividly than William Ash, 57, who recently spoke to The Inquirer in the dining room of the West Philadelphia home he has almost finished paying for.

Ash was sent to Farview in November 1946 after he was convicted of killing a man who was assaulting his uncle during a quarrel over an automobile accident.

Today, one prosecutor said, such a crime would rate a charge of second-degree manslaughter. But it was 1946, and Ash's jury recommended death in the electric chair.

However, Ash was spared by being sent, at age 27, to Farview for "observation" while motions for new trial were being considered.

Farview "observed" Ash until he was 50 years old. Ash says the hardest part of the "observation" for him began one year and one day after he arrived. That was when he got into a fight with a guard and was placed in "J" Ward – the ward for maximum-security, solitary-confinement patients.

"Stripped naked"

"I was stripped naked and had my hands and feet cuffed," Ash recalls. "Then they placed me in a cell that had no sink, no commode, no bed, no blanket, no sheet, no nothing. Just four concrete walls, concrete floor and a ceiling. There was a small window and a small opening in the door."

Ash stayed in a cell for seven years and seven months. The cuffswere removed after he had been there for three years and 11 months. But still he was naked in the bare room.

"They would throw the food together in a small metal bowl," Ash says, "but they would give you no utensils to eat with. You just held the bowl in your cuffed hands and put your mouth down into the food."

In the winter, Ash says, the guards often would open the window during a snowstorm, allowing snow to blow and melt on the floor. Then at night, the cell would get cold enough to freeze the water into a light glaze on which Ash had to sleep – naked.

When Ash went into the cell on "J" Ward, he was 28. When he came out, he was 36. 14 years later, he was transferred to the state prison. After a few months there, he was paroled.

Other inmates of Farview were more fortunate. They recall ordeal that lasted not for years but for days – such as being strapped to hard benches while guards in cushioned rocking chairs looked on.

They recall doctors making the rounds of the wards and addressing each patient's question or request with such responses as: "You're just as crazy as a s–-house rat" or "You're a faker" or "You're a pest."

They remember that the medication prescribed for them was chosen more often by the guards them by a physician and often consisted of powerful drug injections designed to disorient and immobilize a man.

Charles Simon, who spent 30 years at Farview, says he was never given medication during all that time, and, in fact, had trouble getting an aspirin.

"But if the guards thought you were too big or strong or belligerent, or if they wanted to render you helpless so they could do something to you, they might ask the doctor to prescribe some Sparine or Thorazine as a tranquilizer that would make you a zombie," he says. Simon, who left Farview in 1970 because of court found that he had been illegally committed, lives in retirement in Bristol, Pa.

Another patient recalls that the guards themselves administer drugs, both orally and by injection, "and if you refused to shot, the guard would hold you down and give you a shot right through your trousers."

Yet the drugs are the only therapy for at least 85 percent of the patients, according to Dr. McGuire, the former superintendent.

"When I went to Farview in early 1974," he says, "there simply was no treatment going on, except bad treatment. They're using drugs as the answer to every problem.

"The actively popped Sparine into patients regardless of their mental problem or physical condition," he says. "And Sparine is a drug that most hospitals stopped using at least a decade earlier because it can have dangerous side effects and because there are better drugs available.

"The scary thing about the indiscriminate use of drugs is the easy availability of contraband alcohol. The mixture of alcohol with a very powerful drugs present a potentially dangerous hazard to patients, but no one seemed to even think about that."

Other aspects

No one seemed to think about other aspects of the patients' lives of Farview either.

A number of patients remember being deprived of toilet paper unless they perform tasks for the guards, who could then declare the patient a "good boy" and dispensed to him one or two sheets of toilet paper. Many patients recall having to use scraps of newspaper – or their hands – to clean themselves.

The patients say they were all out one shower a week, if they were "good boys."  They then had to dress without toweling.

After stating that his "personal priority" had been to stop the "kicking and beatings," Dr. McGuire said in his final report to the Secretary of the Department of Public Welfare that a second priority was "to attempt to stop the peculiar and dangerous and/or ineffectual use of medications."

"The race was to train enough (attendants) to avoid a death by ignorant overdose or thoughtless combination of drugs. The unauthorized use of medication by guard staff is also highly suspected, but extremely difficult to prove and highly dangerous for the patient."

Regardless, to this day guards to give patients shot as well as oral medications, according to highly placed administrators at Farview, even though only a handful are trained to do so.

Shower policy

Dr. McGuire came to Farview, one of the changes he implemented was the subject of the following memo:

"Effective Friday, August 16, showers on each ward are to be open and available to every patient daily."

But, aware of the atmosphere that existed between patients and guards, he apparently felt compelled to add a paragraph:

"If any patients do not wish to take a shower, they are not to be forced to do so... "

When the new program was announced, Dr. McGuire was told that there was no sufficient supply of towels for daily showers by patients and the laundry facilities were inadequate to provide enough clean ones.

Shortly thereafter, Dr. McGuire's wife found six dozen new towels in the supply closet. Then, Dr. McGuire discovered that one reason the laundry could not supply clean towels was that it was being used to launder guards' uniforms, a departure from state regulations.

He also discovered that patients working in the laundry were charging other patients money to launder their clothes, which is illegal. Hence, another memo from Dr. McGuire:

"Blackmail system for patient personal laundry has been operating for years – why was it allowed?"

But the laundry system was not the only questionable activity that had been allowed for years. Until 1974, guards were allowed to ask for eggs as an alternative course with every meal, even though the eggs had been brought for the patients. Patients were not allowed eggs – ostensibly because the kitchen facility was not large enough to cook eggs for the 475 patients as well as for 320 guards.

The only silverware allowed patients were soup spoons, which could not cut meat. So, on the rare occasions when meat was served, patients had to eat it with her hands. Not having any napkins, they would resort to wiping greasy fingers on their clothing.

Guards' viewpoint

Tomatoes and peaches were produced on the hospital farm. However, when they were presented to the patients at mealtime, according to several sources, they were still in bushel baskets just as they had come from the field – covered with dust, dirt or mud.

"The guards simply could not visualize the patients as human beings," Dr. McGuire told The Inquirer. "They insisted, by their own words, attitudes and actions, the patients were animals – dogs, not people."

In his final report to the secretary of public welfare upon his resignation, Dr. McGuire reiterated:

"There is a mindset shared by the staff and the community which insists that patients are not really human beings with rights, or animals to be caged, watched and beaten if they do not conform."

To many blacks and Puerto Ricans at Farview, verbal abuse is added to the psychological and physical abuse. Racial slurs are commonplace and minority patients (who are only barely a minority of Farview) are subjected to added derision.

Dr. McGuire and others verify the claims of black and Spanish-speaking former patients interviewed by The Inquirer. Joseph Jacoby, a criminologist who supervised interviews with 269 former Farview patients, pointed out to the committee of the State Legislature in 1975 that, while nearly half of Farview's inmates are blacks from Philadelphia and Pittsburgh, not a single member of the guard staff, recruited mostly from the rural areas around the Farview, is black. He called it "a duplicate of the situation at Attica," the New York State prison were 41were killed in an inmate uprising in 1972, and urge that the situation be corrected. It is not then. Currently, Farview staff of ___ includes just two blacks.

One patient, Walter Buress, Jr., wrote in a letter to the hospital superintendent two years ago: "I'm extremely tired of being treated with a prejudicial racist attitude by people here. I am not an animal, nigger or a jigaboo. I am a man!"

Patients who spent time at Farview, whether recently or long ago, tell the same story – a story not just of mistreatment, but also of the absence of beneficial therapy.

John McCullough, a patient in the early 1960s, says his days on the wards were filled with walking single-file in a circle until he chose to sit on the bench.

"The key thing in the guards' minds seem to be that all the patients walk in a circle in the same direction," he says.

Going outdoors

Leon Ziegler, who was released from Farview 1974 after eight years, recalls one year in which patients other than trustees were allowed less than 40 hours "outdoors."  Outdoors, said Ziegler, meant this:

"We would have almost 1,000 men in a tiny mud hole of a yard, with one (bathroom) on each side, and homosexuals would occupy them immediately. We would be outside about 45 minutes and the guards would decide it was time for everybody to go back inside so they (the guards) could flop their butts back into those rocking chairs."

Two activities specialists from Harrisburg State Hospital made a survey of Farview's activities program two years ago and arrived at the following conclusions:

"The problem is that the program appears to be for only a very few clients and that was done is done for the wrong reasons. Time and again we saw a small, well-equipped work activity area with a few favored clients working with a good staff member. By 'favored', I mean that those allowed in the program are spared the pervasive drudgery and boredom of spending their days on the wards.

"The central damning criticism of the system there, as we saw it, as this: what about the other 85 percent of the patient population who also need meaningful activities, the Joy of work, and human relationships often formed in the work-activities setting?"

Former and present patients and staff members maintain their facilities exist for more activities, but that none are offered.

Dr. McGuire says the gymnasium and the three-lane bowling alley are seldom used – because the guards do not want to bring only a ward or two in at a time to use them. He says the recreation personnel do not want to have the floors scuffed.

The Harrisburg State Hospital specialists also mentioned the gymnasium and bowling lanes in the report:

"In the therapeutic recreation area, little activity can be observed at the beginning of the afternoon session. The recreation staff gives the appearance of being poorly prepared for the arrival of the patients, as a result, activities are not prompt in starting and are slow in attracting interest from patients. A three-lane bowling alley, a large, well-equipped gymnasium, and spacious outdoor recreation areas seem to be used on an irregular basis and are not always accessible to patients during scheduled recreation periods."

And in the workshop areas:

"The small number of men are placed in the workshops without prior evaluation and testing for appropriate placement. The group remains almost stagnant, spending many hours each day repeating already familiar procedures in completing the same projects over and over; there are no clear lines of progression for the men from these lower-level projects to more skilled vocational activity."

All these things are known to state authorities as well as the administrators of the other state institutions.

"Within the state system," says Dr. McGuire, "Farview has a reputation for toughness, harshness and minimal treatment. Guards basically run the institution. Everything is done for their pleasure and convenience."

When McGuire, who said he resigned once he had discovered that he was unable to make meaningful changes to improve the mental condition of the patients, speaks of Farview, uses words like "dehumanizing" and "harsh."  The institution "unquestionably gave the message to the patients that they were less than human," he says.

A final irony: for all this, patients of Farview from the state deems able to pay our bill, according to their ability to pay, up to $75 a day – or more than $20,000 a year – for their "care and treatment."  In fact, Mrs. almond Jackson, whose son Robert (Stonewall) Jackson died under suspicious circumstances at Farview 10 years ago, was billed $860 after his death.

She paid.