RERUN: Even A Suicidal Man Will Fight For His Right To Remain Free From Oppression And Abuse

This article was first published in late May, 2012. It is actually an essay and not an article, and relates directly to my diagnosis as a person affected by mental illness specific to my given diagnosis- major depressive disorder, and associated traits, including suicidal ideation (now in remission). I offer it here today as an example of material that is included in my evolving manuscript and the pending publication of my book, at the suggestion of a trusted friend. 

     "I don't run for pleasure here at ASH. I run to escape. I run to get away  from you, and the negative energy that flows from your very pores. I run to escape you and your kind, your goddamned incompetence. I run to escape you...." (My exact words to Dr. Pervaiz Akhter, August, 2011)

      My general reactions to the abuse at The Arizona State Hospital (ASH) were both instinctual and intellectual, for I am no less an animal or human being on the basis of my mental disorder, than I am an ethically sound and socially educated member of my culture and society. Beyond what I sincerely believe was a reasonably well rounded introduction to compassionate concern for human and nonhuman animals and other life forms when I was a boy, I was also privileged to work for several semesters as a researcher and teacher's assistant (RTA) to a very reputable heath care ethicist (Dr. Joan McGiver-Gibson) in the University of New Mexico General Honors Program, this during my undergraduate education, circa 1994-1996. I was also married for a number of years to an MS level nurse practicioner who falls nothing short of an excellent care provider in her given work then, and today; and in a "former life" (circa the 1980s), I actually worked as an EMT in the public emergency medical services environment. In general, ergo, I think it's fair to say that I have reasonable familiarity with- and even a bit of a calling- in terms of health care ethics, largely because of my related respect for and deep appreciation of dignity; and well before I wound up in the hands of the malpractitioners at ASH, I had come to understand how vulnerable the dignity of vulnerable adults is, even today, in contemporary America.
      It is partially because of these specific aspects of my background that my attention was immediately drawn to the graphic abuse that occurs at ASH on a day in and day out basis; I had spent the previous 8 months in similar facilities in Tucson, and during that time, witnessed clear tension that did illustrate the challenges that mental health workers face in their given positions in such settings, but at no point in that time did I find myself overly troubled by the behavior of staff, beyond relatively insignificant terms. Nothing, that is, outside of what anyone might experience in any given hospital. 

But at ASH, the staff misconduct was everywhere (on the unit, off the unit, in formal meetings of my treatment team, and so on), and it was loud (screaming nurses for no reasonable cause, etc.), utterly unavoidable (regardless of how civilly/lawfully a patient conducts their behavior at ASH, they will invariably encounter staff who thrive on treating the patients like dirt- or worse), and any given time, imparted by staff at every level of employ (licensed psychiatrists willing to ignore staff behavior that is clearly of criminal nature, administrators committed to manipulating any reports of such misconduct, and direct contact nurses and technicians with no seeming understanding of common civility and established heath care ethics).

      It was in that atmosphere, over a period of 3-4 months during the first half of my hospitalization at ASH, that I came to sense a very real need for someone- anyone- to take on the task of addressing these issues; but nobody there- staff, that is- was up to it, including my primary attending doctor during those months, Dr. Laxman Patel, who I did in fact report to the abuse that I was witnessing, or outright experiencing, in the context of clearly unlawful staff misconduct. But he refused to so much as hear me out. As follows:

     "These things are not my concern as your doctor… What do you think? Do you think you can change the system? You need to pay attention to yourself, and not concern yourself with the other patients…" 

     (September 2013 update: this man, Laxman Patel, has since been promoted at ASH, and is now the Chief Medical Officer there, with more authority over the treatment of all of the ASH patients as a whole. This is business as usual at ASH... It really is that bad.) 

     Herein, I recognized a deeper crisis, one of incomprehensible proportion, and beyond anything I would have formerly believed could exist today, in contemporary America. Thus, as my depression did in fact subside- through time and a basic regimen of antidepressant medication, mind you, versus as a direct result of the substandard personal treatment I was subjected to at ASH- and I in turn sensed a renewed interest in the my surrounding environment, I became dedicated to addressing the wrongdoing at ASH to the best of my ability, there and then, while still experiencing these conditions on a daily basis. 

Personal journal note, April, 2011: "I have to dedicate myself to this shit , because the abuse is rampant, and I refuse to ignore it. Bottom line."

     And as I have tried to describe, I also learned the hard way over time that the patterns of abuse at ASH extend far beyond the basic misconduct of the technicians and nurses, wherein senior level clinical staff- particularly the psychiatrists at ASH- actively condone the substandard conditions as a matter of standard practice, with the blatant support of  executive level administrators at ASH and in the AZ Department of Health/Behavioral Health Services.  It was directly due to that, the negligent mishandling of my most serious grievance reports (which as noted in some of my most recent articles, is still ongoing) that my dedication to addressing patient abuse and related staff ineptitude at ASH escalated to the point that it has, to date. For I know that if not for the willingness of such high ranking of high ranking state employees to further the overall substandard conditions at ASH, the presence of patient abuse that is most typically imparted by lower ranking staff (nurses and technicians) would likewise not occur to nearly so rampant a fashion. As such, the Hospital and its overseeing authority base is nothing more or less than a system, and systems are comprised of nothing more or less than individuals, and I came to realize precisely how to best address these issues as I engaged in my advocacy there in ASH itself.  
       As noted, my fundamental instincts and related knowledge base compelled me to cry "FOUL!" as soon as I found myself being subjected to gross violations of my rights at ASH. It doesn't take a rocket scientist to understand how fundamentally wrong hospital patient abuse is, but many emotionally and mentally disabled adults struggle with the reality of abuse subjected upon them for any number of pathological or emotionally grounded reasons; coping skills, specifically, are a big challenge for most if not all emotionally vulnerable adults, and seriously mentally ill persons often lack the basic cognitive skills to normally or meaningfully respond to abuse. Some ASH staff across the board (many/most, but not all) take unfair and grossly bad faith advantage of these dynamics of the disabled patients at ASH, and herein lies the undeniable fact that violations of the Americans With Disabilities Act- specific to the issue of discrimination on the basis of given disability- do occur at ASH as a matter of standard practice. It is so much that, standard practice, that for many of the patients, as well as those staff unable to recognize their own shortcomings in this context, it is a given way of life. But this in itself is at the root of the purpose and findings at the ADA, in fact, for in America today, this is not to be allowed, not as a matter of practice, and certainly not as a way of life. 
     It is critical to realize, as well, that not all mentally disabled adults are deeply affected by cognitive limitation or related sense of morals and ethics, and I met more than one highly intelligent and emotionally strong patient during my thirteen months at ASH; therein, from reasonably lucid patients who have been at ASH for many, many years, I further came to learn just how deeply embedded the presence of patient abuse is at ASH. My own cognitive skills and directly related coping skills, including in terms of fundamental instinct, were never much at issue during the period of time that I was hospitalized at ASH (although certain clinical staff tried to attribute their own wrongdoing to my given behavioral characteristics, this again, as a matter of standard practice), and much to the chagrin of the doctors and administrators there, my right to exercise dissent in the face of graphic human rights violations and related abuse was never something I lost touch with. This, in spite of systematically applied retaliation and other like methods by which ASH administrators attempted to suppress my voice. Applied, as I will continue to emphasize, as a matter of standard practice. 
       I am taking the time to describe these things because it's typically difficult for others to understand why a person with major depression and ongoing suicidal tendencies- a person like I, that is- would even care about things effecting the normal course of their life experiences. I can easily relate to this issue, too, for even through my own experience, I recognize how crippling depression is in itself; and intellectually speaking, it does seem a bit nonsensical to think that a person wanting to die would really give a hoot about  matters relating to quality of life. But through my own experiences, I can also attest to the fact that depression and suicidal ideation do not necessarily strip a man of his most fundamental need to live life in a reasonably comfortable way, not when it comes to the presence of abusive forms of authority over his day to day life, or even in the context of engaging in proactive forms of positive experience while one's subjective life is still ongoing.
       Fairly early on, in what later and somewhat unexpectedly developed into long term hospitalization for major depressive disorder and associated suicidal ideation, my first psychiatrist at the University of Arizona Medical Center (Dr. Richard Van Rhoades, Tucson, circa early summer 2010) posed questions to me about these things, for I was able to describe to him, the fact that at no time during my progressively downward spiraling struggles with depression (which has effected me off and on again to varying degrees of intensity since I was about 12 years old) did I ever entirely give up my basic activities as a physically active and intellectually inquisitive human being. Dr. Van Rhoades is a very good man, and in my learned opinion at this juncture of my life, I also feel that he is one of the most competent mental health professionals I might ever hope to encounter (in a class altogether above any of the psychiatric doctors at ASH). As my first psychiatrist, he very comfortably, almost casually, granted me his full trust (of heart, and of mind) when it came to asking me to disclose my most personal thoughts in relation to suicidal intent, and as that relationship formed over a period of 2-3 weeks, I was relieved to learn that I could trust him, as well. He was both willing to listen to me as well as teach me, and he did this without challenging my way of  "seeing" things, which is tantamount to accepting how I feel abut things, too. Dr. Van Rhodes never condoned my suicidal thinking, mind you, but he also refrained from alienating me through any outright rejections of my honest and good faith expressions about my still evolving understanding of these things; and it was only through his craftsmanship and related compassion as a psychotherapist that I became willing and able to accept my suicidal thinking as being distorted at its core. Had I not come to accept this when I did, I know that I would not be alive today, bottom line, for this is manner in which Dr. Van Rhoades convinced me to "stick around", versus doing what many/most voluntary patients do- checking out before the process of treatment had any effect. 
       In the context of my own consideration at that time of what it meant to me, this being able to engage in "life affirming" activities while also finding myself increasingly effected by acute suicidal ideation, circa 2004-2010, I also feel that Dr. Van Rhoades came to understand a little bit more about the simple fact that not all depressed or suicidal adults have given up altogether on enjoying their respective moment to moment experiences as organic living beings in reasonably comfortable fashion (despite the given circumstances of their depression); and his willingness to grant me the dignity of having appreciation for certain aspects of life itself despite me being mentally ill also benefited me in the sense that my by then very diminished sense of self worth began healing. I carried this positive energy with me after I was transferred away from Dr. Van Rhodes care, and it served me well during my time at ASH, where the clinical setting is nearly devoid of positive stimulation, and where, in my experience, the psychiatric doctors are so lacking in basic communication skills that they rarely inquire as to a patients stream of conscious thoughts.  
      The topic of "life affirming" activities came up again as soon as I left Dr. Van Rhoades' care and treatment, but at ASH, my continued interests (despite my mental illness) in  aesthetics and enjoyment were so confounding to my care providers that I believe they actually resented it, in a way. While hospitalized at ASH, for example, I pretty quickly dedicated myself to an intensive running program, which I initiated of my own volition and then successfully fostered over a 2-4 month period of time, to the extent that I was able to lose over forty pounds within 6 months, this as per one a self assigned goal; I also spent a moderate amount of my time working on and completing portraits of human faces (in pencil, taken from photos), writing poetry, and playing piano. In no uncertain terms, these activities offered me direct diversion from the day to day stresses of staff misconduct there at ASH, and I came to appreciate these diversions because they effectively added up to the best therapy available for a patient like me at ASH; but in contrast, most of my care providers there were unable to grasp and/or accept the fact that a person who experiences ongoing suicidal ideation can also have very clear standards in terms of how they experience life itself. This is not to say that all of these individuals were necessarily unable or unwilling to accept my practices in this context, but I did get the impression that it was unusual.
       At a late summer, 2011, meeting of my ASH inpatient treatment planning "team," I was asked by one of the physical medical doctors (vs. psychiatric doctors) to comment on my successful "weight loss program", which as I have stated already, came about through nothing more mysterious than 4-5 days a week of running there at ASH (and which I had to fight to do, in effect, because over my first 4-5 weeks of beginning that, I was constantly harassed by grossly overweight and basically lazy security staff, who seemingly resented the fact that I could do that, run for 30-60 minutes at a time, in the heat of summer, and in spite of said harassment….). I was, at the time of this meeting, in the thick of a serious conflict with my then primary attending psychiatrist, Dr. Pervaiz Ahkter (who is a native of Pakistan with a medical degree from an unaccredited college in that country, and who stands in my acquired memory as one of the least qualified medical professionals I might ever have to encounter), and without really thinking about it, I immediately responded to the inquiry about my "weight loss program" by looking Dr. Pervaiz Ahkter in the eye and stating:

          "I have always enjoyed running, so it wasn't really all that hard for me to initiate and maintain my running schedule once I was granted the option- security guards aside. But I don't run for pleasure here at ASH. I run to escape. I run to get away  from you, and the negative energy that flows from your very pores. I run to escape your kind, and your goddamned incompetence. I run to escape you. I have never had to run like this." 

       Again, I have explained these things because I know that it may be difficult to understand how I, a diagnosed mentally ill person who has dealt with chronic acute suicidal ideation for the virtual entirety of my adult life, could also entertain an ongoing interest in proactive, "life affirming" activities. I have never cared about convincing anybody of anything in terms of my own personal thinking and related mental health issues, either. But there is another reason, yet, to why I am sharing these added elements of my experiences at ASH, and it looks like this:
       Before long, the rat bastards in the Arizona Department of Health Services and their lawyers will do a all they can to assail my basic credibility as a witness to my own experiences at The Arizona State Hospital. I am as certain of this as I am of my name. The way I see it, these people practice their profession(s) in a very distorted way, displaying an almost subhuman perspective that seems to be fostered by a basic distrust of their fellows and possible malice towards living things in general, and a related inability to trust themselves (which they assuredly know, in there own right); these factors, coupled with their attendant willingness to discriminate against weaker members of our community (mentally disabled and emotionally vulnerable persons such as myself) will almost definitely compel these vermin to do all they can to make me the problem. They will likely do this as matter of strategy, as they apply whatever tactic they need to in order to defend their interests, and I know that they don't care one bit about who gets hurt in the process.
       It is, thus, my concern today that the "pending matters" referred to in the letter I just got from the Arizona Office of Administrative Hearings (see May 30, 2012,"Delays, Delays, Delays), by which the long overdue scheduling of my pending court cases in that venue still haven't been scheduled (despite my pointed inquiries on the topic) may have everything to do with the state's possible intent to challenge my actual standing as a member of Arizona's mentally ill population/community. This type of strategy is common in politics, particularly corrupt politics, and the state officials that I at odds with today are about as corrupt a pack of people as one might find in contemporary American society. It won't take much for them to establish a storyline of sorts, whereby an attempt could be made to characterize my voice as nothing other than that of a charlatan, litigant, antagonist, or fanatic; and with whatever momentum brought about therein, I may be made out to be the fundamental reason for these conflicts- me, and not the wrongdoing that I am dedicated to exposing and addressing. I have already experienced this basic condition in the recent past, and from my many experiences at ASH in this context, I am convinced that it is the only way they know how to operate. Blame the patient (cite delusion, bad faith, or outright deception), deflect the facts, and rely upon the stigma against mentally ill adults to hammer the final nail into that proverbial coffin.
       When the devils at ADHS and in the Arizona Attorney Generals Office come after my credibility, I anticipate an all out assault on the verity of my being afflicted with mental illness, in the first place. I can do this, foresee the possibility in fairly clear terms, because I have already experienced the confusion that people often have over the complexities of my particular mental illness, as already described here in this article. But this confusion has largely been in the context of things like writing poetry, or finding enjoyment in playing the piano, and running, and when the time comes for me to have defend my status as a diagnosed mentally ill person, I don't really know how I will handle it.
       I have never cared about convincing anybody about anything in terms of own personal thinking and related mental health issues. If Dr. Van Rhoades didn't possess the fundamental sensitivity and associated respect for me as a human being who is capable, as such, of exclusive ownership of my own personal identity despite of my being effected by mental illness, I would have never progressed beyond week one of my eventual 21 full months of hospitalization as a mental health patient. The fact is, while Dr. Van Rhoades was willing and able to value my given attributes as man affected by mental illness, the psychiatric clinicians at ASH were and are- by and large- incapable of treating vulnerable persons which anything other than utter disdain. Those people (where do people like this come from?) each the every one of them, sought to alienate me form my given attributes, this is order to distract me from my willingness to openly report the unconscionably substandard conditions at ASH, including in terms of challenging my very diagnosis, suggesting in effect that I was not suicidal, in fact. I knew then that I don't present the loudest classic symptoms of serious mental illness, and I'm far from entirely comfortable with accepting the full burden of knowing that I am legitimately mentally ill, even now, following these many months in a small host of full on insane asylums. 

But I refused to give in to the pressure that was directed towards me, be it in the form of very real physical and emotional abuse, and therein I found the means to beat those rat bastards at their own game. I attest to this from the heart, for therein I identified the means to survive The Arizona State Hospital. Sadly, few other patients at ASH find their way in this context, and the ones granted the privilege of overseeing the life needs and affairs of such patients take grossly bad faith advantage of these dynamics as a matter of standard practice. It is that bad. 

IN CLOSING: At this last, very recent judicial review of one of my most serious grievance reports, May 17, 2012, assistant AZ Attorney General Joel "the mortician" Rudd had the audacity to declare that I suffered no detrimental effects as a consequence of the Arizona Department of Health Services failure to meet very clearly required time line violations. Suffice it to say, this audacity is anything but unusual in the legal business, but for a lawyer to be stating something that only a mental health professional, or a client in fact, can validly attest to, is unconscionable to the third degree. Conduct unbefitting the profession, I should add, and clearly inconsistent with anyone possessing sound ethical standards.
      Just another day in the world, when it comes to The Arizona State Hospital and its parent agency with the state. Obviously.

FAST FORWARD SEPTEMBER, 2013: I must again express my heartfelt thanks and deep appreciation for the quality of care at the University of Arizona Medical Center South Campus (formerly PPH/Kino Hospital), with particular regard for my primary caregivers there, including but not limited to Dr. Richard Van Rhoades, Dr. David Stoker, Skipper, Mark, and far more individuals than my feeble memory bank can recall by name (I do remember your faces, voices, and personality based character, though); and my heart still sinks today in terms of Kevin's untimely passing. If not for the care and guidance of these individuals, I greatly doubt I would be here now, writing this today, safely located (finally!) in my home town of Santa Fe, NM. Likewise, I can now attest to how critically necessary such quality of care is in terms of any seriously mentally ill persons well being and general needs, and I feel safe in presuming that myriad other patients of these caregivers are doing well today. 

These facts fly in the face of the dismally substandard medical-mental health care and practices at The Arizona State Hospital. As such, the administrators and senior clinicians at ASH should be ashamed to the core, but I highly doubt that is possible, for in my experiences to date, they are beasts of utter depravity. And as national awareness specific to the fact the substandard mental health care across the board has directly contributed to a range of graphically horrific tragedies, it is equally clear that The Arizona State Hospital stands as one of the worst facilities in operation today with this particular issue in mind- be it in Arizona, or not. 

I contend that ASH is Arizona's dirtiest secret today, the implications of which have undeniable national significance. And at this point, I am no longer alone in seeing this.

My door is always open to anyone of like mind and sense of purpose. I need your help.  The patients at The Arizona State Hospital need our help. Now. 

paoloreed@gmail.com