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Full text of "Drugs in institutions : hearings before the Subcommittee to Investigate Juvenile Delinquency of the Committee on the Judiciary, United States Senate, Ninety-fourth Congress, first session, pursuant to S. Res. 72, section 12, Investigation of juvenile delinquency in the United States : the abuse and misuse of controlled drugs in institutions ... July 31 and August 18, 1975"

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DRUGS IN INSTITUTIONS 



HEARINGS 

BEFORE THE 

SUBCOMMITTEE TO INVESTIGATE 
JUVENILE DELINQUENCY 

OF THE 

COMMITTEE ON THE JUDICIARY 
UNITED STATES SENATE 

NINETY-FOURTH CONGRESS 

FIRST SESSION 

Pursuant to S. Res. 72, Section 12 

INVESTIGATION OF JUVENILE DELINQUENCY IN THE 

UNITED STATES 



THE ABUSE AND MISUSE OF CONTROLLED 

DRUGS IN INSTITUTIONS 

Volume HI 

Formerly Institutionalized Persons and Physicians; 

Mental Health, Mentally Handicapped and Criminal, 

Juvenile Justice Systems 



JULY 31 AND AUGUST 18, 1975 



Printed for the use of the Committee on the Judiciary 




FRAN T ' W CENTER 

C • 3 3 01, 

jjj MAS | - 1977 



Bested P>!fe!!c 
Boston ;._.., 




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DRUGS IN INSTITUTIONS 



HEARINGS 



BEFORE THE 



SUBCOMMITTEE TO INVESTIGATE 
JUVENILE DELINQUENCY 



OF THE 



COMMITTEE ON THE JUDICIARY 
UNITED STATES SENATE 

. NINETY-FOURTH CONGRESS 

FIRST SESSION 

Pursuant to S. Res. 72, Section 12 

INVESTIGATION OF JUVENILE DELINQUENCY IN THE 

UNITED STATES 



THE ABUSE AND MISUSE OF CONTROLLED 

DRUGS IN INSTITUTIONS 

Volume III 

Formerly Institutioxalizp:d Persons and Physicians; 

Mental Health, Mentally Handicapped and Criminal, 

Juvenile Justice Systems 



JULY 31 AND AUGUST IS. 1975 



Printed for the use of the Committee on the Judiciary 




u.s. government printing office 

83-303 O WASHINGTON : 1077 






COMMITTEE OX THE JUDICIARY 

(94th Congress) 
JAMES O. EASTLAND, Mississippi, Chairman 

JOHN L. McCLELLAN, Arkansas ROMAN L. HRUSKA, Nebraska 

PHILIP A. HART, Michigan *->, HIRAM L. FONG, Hawaii 

EDWARD M. KENNEDY, Massachusetts HUGH SCOTT, Pennsylvania 

BIRCH BAYH, Indiana STROM THURMOND, South Carolina 

QUENTIN N. BURDICK, North Dakota CHARLES McC. MATHIAS, Jr.. Maryland 

ROBERT C. BYRD, West Virginia WILLIAM L. SCOTT, Virginia 
JOHN V. TUNNEY, California 
JAMES S. ABOUREZK, South Dakota 

Peter M. Stockett, Jr., Staff Director and Chief Counsel 

Subcommittee To Investigate Juvenile Delinquency in the United States 

(94th Congress) 

BIRCH BAYH, Indiana, Chairman 

PHILIP A. HART, Michigan CHARLES McC. MATHIAS, Jr., Maryland 

QUEXTIN N. BURDICK, North Dakota ROMAN L. HRUSKA, Nebraska 

EDWARD M. KENNEDY, Massachusetts HIRAM L. FONG, Hawaii 

John M. Rector, Staff Director and Chief Counsel 

(ID 



CONTENTS 



Volume I 



Interstate Placement and Traffic in Children and Their 

Drugging 



Page 
Opening statement by Senator Birch Bayh, chairman 1 

ALPHABETICAL LIST OF WITNESSES 

Brandt, Anthony, author/journalist, Shrub Oak, N.Y fl7 

Chamberlin, Judi, Bellingham, Wash f86 

Clements, Dr. James, M.D., director, Georgia Retardation Center, 

Atlanta, Ga fill 

Dunbaugh, Frank M., Deputy Assistant Attorney General, Civil Rights 

Division, Department of Justice 4 

Ellis, James W., staff attorney, Mental Health Law Project, Washington 

D.C *273 

Ferleger, David, director, Mental Patient Civil Liberties Project, Phila- 
delphia, Pa *163 

Gotkin, Janet, Croton-On-Hudson, N.Y ' — f4 

Hudson, Wade, Network Against Psychiatric Assault, San Francisco, 

Calif t31 

Kaufman, Dr. Edward, M.D., medical director, Lower Eastside Service 

Center, New York, N.Y fl03 

Lamere, Tony, Great Falls, Mont t97 

Lehr, Dennis J., partner, Hogan & Hartson, Washington, D.C *4 

Lennox, Craig, Pasadena, Calif f27 

Marker, Gail, M.S. W., Mental Health Law Project, Washington, D.C *282 

Thrasher, Louis, director, Office of Special Litigation, Civil Rights Divi- 
sion, Department of Justice 4 

Wendel, Dr. Herbert A., M.D., associate professor of pharmacology and 
head, Division of Clinical Pharamacology, Health Sciences Center, 

University of Oregon, Portland, Oreg- 1 1 27 

Wooden, Kenneth, investigative researcher and author, Yardley, Pa 27 

CHRONOLOGICAL LIST OF WITNESSES 
Thursday, July 31, 1975 

Dunbaugh, Frank M., Deputy Assistant Attorney General, Civil Rights 

Division, Department of Justice 4 

Thrasher, Louis, director, Office of Special Litigation, Civil Rights Division, 

Department of Justice 4 

Wooden, Kenneth, investigative researcher and author, Yardley, Pa 27 

LIST OF EXHIBITS 

1. Article: Texas "Jails" for Troubled Teens, by Seth Kantor, from the 

Detroit News, June 15, 1975 15 

2. Article : Texas Child-Care Bonanza, by Seth Kantor, from the Detroit 

News, June 16, 1975 17 

•Appear In Volume II. 
tAppear in Volume III. 

(m) 



IV 

List of Exhibits — Continued 

3. Article: Texas Child-Care Probes Due, by Seth Kantor, from the De- Pa s e 

troit News, June 17, 1975 19 

4. Article: The Child-Care Empires, by Seth Kantor, from the Detroit 

News, July 20, 1975 20 

5. Article: Brothers' 5- Year Nightmare, by Seth Kantor, from the Detroit 

News, July 21, 1975 22 

6. Article : Child Placement Compact Is Operative for 33 States, by Seth 

Kantor, from the Detroit News, July 21, 1975 24 

7. Special Report: Child Welfare Abuses, from Child Protection Report, 

July 3, 1974, Washington, D.C 25 

8. Article: CHAMPUS: Wasting the Youths, by Ken Wooden, from 

Fortune News, November 1974 34 

9. Article: Senator Jackson's Opening CHAMPUS Hearings, from For- 

tune News, November 1974 35 

10. Article: Ken Wooden's Unheard Testimony, from Fortune News, 

November 1974 36 



APPENDIX 



Part 1 — Interstate Compact on Children 

Extradition of Juveniles and the Interstate Compact, by Richard North, 

from the Clearinghouse Review, June 1974 43 

Interstate Compact on Juveniles — Its Progress and Problems, 1955-1960, 
by Gordon A. Martin, Jr. from Crime & Delinquency, April 1961, pp. 

121-30 45 

Standard 16.6 — Regional Cooperation; extract from a report by the Na- 
tional Advisory Commission on Criminal Justice Standards and Goals, 

1973, pp. 565-6 55 

The Legal Status of Runaway Children, by Herbert Beaser, J. D. : 

Chapter 2 1 — The Interstate Compact on Juveniles 56 

Chapter 22— The Law in Action 59 

Excerpt from Chapter 23 Recommendations: 6. Interstate compact 

on juveniles 64 

Part 2 — Interstate Placement and Drugging 

Morales v. Turman, [364 F. Supp. 166 (1973)] 65 

Letter of April 2, 1975, to John Rector, Chief Counsel, Senate Subcom- 
mittee To Investigate Juvenile Delinquency, from Patricia M. Wald, 

Mental Health Law Project, with enclosure (*) 

Brief of the Amici Curiae, in the U.S. Court of Appeals for the Fifth 

Circuit, No. 74-3436, Morales v. Turman (*) 

An Illinois Tragedy : An analysis of the placement of Illinois wards in the 
State of Texas, by Patrick A. Keenan, DePaul University College of 

Law, Aug. 30, 1973 79 

Nelson v. Heyne [491 F.2d 353 (1974)] 277 

Limits on Punishment and Entitlement to Rehabilitative Treatment of 
Institutionalized Juveniles; Nelson v. Heyne, in Recent Developments, 

excerpt from Virginia Law Review Vol. 60, 1974, pp. 864-83 286 

Letter of August 11, 1975, to John Rector, Chief Counsel, Senate Sub- 
committee To Investigate Juvenile Delinquency, from Michael Grant, 
administrator, Grant Center, Inc., Miami, Fla., regarding CHAMPUS 

and JCAH standards 306 

Gary W., et al. v. Stewart, et al., Civil Action No. 74-2412 Section C, in the 

U.S. District Court for the Eastern District of Louisiana (*) 



*Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



The Interstate Compact on the Placement of Children, from the American 

Public Welfare Association, Washington, D.C., Brendan V. Callanan, Pa £ e 
project director 310 

Tranquilizers — A Critical Look at America's Number One Drug Family, 
by Michael Burkett, from a Publication of the Do It Now Foundation, 
1975 (*) 

Illinois Youths Sent to Canada for Special Treatment Found Housed in 
High-priced Squalor, extracts from Juvenile Justice Digest, Aug. 1, 
1975 323 

Senate Hearings Reveal Widespread Medical Abuse of Jailed, Institution- 
alized Children 324 

Axe May Be Falling, by Seth Kantor, from the Florida Times-Union, 
July 11, 1975 326 

Bayh Deplores Abuse of Confined Children, by Seth Kantor, from the 

Detroit News, Aug. 1, 1975 327 

Senate to Investigate Charge Against Mental Agencies — FDA "Hung 
Up" in Drug Abuse Probe, by Seth Kantor, from the Detroit News, 
Aug. 17, 1975 328 

Inmates Called "Tamed" by Dope, by Seth Kantor, from the Detroit 

News, Aug. 19, 1975 330 

Refugees Drugged, Pentagon Admits, by George C. Wilson, from the 

Washington Post, Sept. 13, 1975 330 

Interstate Business: Troubled Youngsters, by Seth Kantor, from the 

Washington Post, Sept. 21, 1975 331 

Part 3 — Children por Sale 

Subcommittee To Investigate Juvenile Delinquency, excerpts from re- 
ports: 

Rept. No. 1608, 88th Cong., 2d Sess.; pp. 10-11 336 

Rept. No. 1519, 88th Cong., 2d Sess., pp. 19-22 339 

Rept. No. 893, 89th Cong., 1st Sess., pp. 10-12 344 

Rept. No. 1664, 89th Cong., 2d Sess., pp. 9-12 348 

Committee on the Judiciary — Making unlawful certain practices in con- 
nection with the placing of minor children for permanent free care or 
for adoption: 

Rept. No. 2025, 87th Cong., 2d Sess 353 

Rept. No. 1595, 88th Cong., 2d Sess 360 

Rept. No. 126, 89th Cong., 1st Sess 369 

The Baby Brokers, series of articles from the Cleveland Plain Dealer, 
March 1975, by Katherine L. Hatton, et al.: 

Childless Pairs Pay up to $25,000 for Infants Here, Nationwide 378 

Abortion Service Here Refers Some Women to Adoption Lawyer 381 

Lawyer Uses Abortion Services Network To Locate Babies for Private 

Adoption 384 

Lawyer Offers Expenses-Paid Adoption Here 387 

Florida Lawyer Runs Dormitory for Mothers-To-Be 390 

Heartbroken Mother Gave Up Newborn 392 

Like Carl, Many Children Are "Too Old" for Adoption 394 

How I Sold — And Almost Bought — A Baby, by Lynne McTaggart, from 

the New York News Magazine, Apr. 13, 1975 396 

The Baby Peddlers, by Maury Levy, from the Philadelphia Inquirer, 

Feb. 1975 404 

From the Christian Science Monitor, by Curtis J. Sitomer: 

Baby Sales— For Big Profits 413 

Child Adoption: New Federal Policies Needed 414 

Babies for Sale, by Robert Sam Anson and Judith Clifford, from the New 

Times, June 8, 1974 415 

Mr. Levy Goes to Washington, by Maury Levy, from the Last Word 

Interstate Adoption Practices, an interim report of the Subcommittee to 419 
Investigate Juvenile Delinquency, Committee Print Draft, 1956 421 



•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



VI 

Pakt 4 — Child Snatchers 

30/90 day proposal, in support of H.R. 2936, from Children's Rights, Inc., ?*& 

Dec 1 1975 525 

Text of H.R. 2965", 94th _ Cong., 1st Sess 528 

Legislative Review, from Children's Rights, Inc., Nov. 1975 530 

New group leads war on "child snatchers," by Lew Koch, from Children s 

Rights, Inc., July 21, 1975 538 

Child-snatching, by Brian Van Der Horst, from the Village Voice, July 7, 

1975 539 

"Child-snatching" reads like scenario for detective movie, by Sheila Kast, 

from the Washington Star, Aug. 3, 1975 539 

In the legislatures, from the Family Law Reporter, Feb. 10, 1976 o42 

South Carolina— Custody— Child-snatching, from the Family Law Re- 
porter, Feb. 3, 1976 - — 544 

Uniform Child Custody Jurisdiction Act, from the Family Law Reporter, 

Feb. 10, 1976 ---.,--- 545 

Thousands of Parents "Forced" to Resort to Child-Snatching, by Kay 

Bartlett from the Baltimore Sun, Sept. 26, 1976 549 

Part 5 — Drugs Used to Control Students 

Pills for Classroom Peace?, by Edward T. Ladd, from SR, Nov. 21, 1970... 555 
The Children With No Alternative, by Careth Ellingson, from SR, 

Nov. 21, 1970 560 

Principles of Drug Therapy in Child Psychiatry With Special Reference 
to Stimulant Drugs, by Leon Eisenberg, M.D., from Amer. J. Ortho- 

psychiat. (41(3) April 1971 561 

Amphetamine Legislation Hearings, 1971, excerpts from: 

Brandon, Robert, director, Task Force on Drug Abuse, pp. 198-213 . . ( *) 
Jaffe, Dr. Richard, Clinical Center, National Institutes of Health, pp. 

214-34 (*) 

Ewing, Mrs. Margaret, attorney, National Legal Program on Health 

Problems of the Poor, pp. 234-8 (*) 

Exhibit No. 29, letter of July 13, 1971, from Al Weese, coordinator. 

Drug and Alcohol Division, Office of Human Resources, City of 

Seattle, Wash. ; with dialogue about tranquilizers Preludin, Ritalin, 

and Eskatrol being classed as Schedule II drugs, pp. 320-4 ( * ) 

Exhibit No. 42, letter of Sept. 9, 1971, from John M. Rector, to 

Robert Brandon, project director Task Force on Drug Abuse ; and.- ( *) 
Exhibit No. 43, letter of Sept. 24, 1971 from Steven T. Was, co- 
director, Task Force on Drug Abuse, to Hon. Birch Bayh, pp. 

453-6 ----- -r- (*) 

Just a Little Pill To Keep the Kid Quiet, by Roger Rapaport, from the 

Los Angeles Times, Apr. 25, 1971, pp. 630-4 (*) 

Drugging and Schooling, by Charles Witter, pp. 803-4 -_-- ( ) 

Disciplinary Principles and Behavior Changing Drugs, by Edward T. 

Ladd, from Inequality in Education, pp. 817-25 ( ) 

Hyperactivity: A Political Malady?, by Tom Parmenter, from In- 

equality in Education, pp. 825-8 t~~t~i~~j 

Drugs and Hyperactivity: Process Is Due, by Roderick L. Ireland 

and Paul R. Dimond, from Inequality in Education, pp. 834-9.- - ( ) 

Drugs for Hyperactive Children — The Case of Ritalin, by Alan I. 

Charles, from the New Republic, Oct. 23, 1971, pp. 840-2 (*) 

Amphetamines— Treatment for Fidgety Kids?, from the National 

Observer, July 6, 1970, pp. 851-3 -- (*) 

Omaha Tries Peppy-Pupil Pills, by Robert M. Maynard, from the 

New York Post, June 29, 1970, pp. 853-5 --— (*) 

Omaha Pupils Given "Behavior" Drugs, by Robert Maynard, from 

the Washington Post, June 29, 1970, pp. 855-9 __ -- (*) 

Scientists Ratify Drug Use To Control Children, by Robert C. 

Maynard, from the Washington Post, Mar, 11, 1971, pp. 859-60 . ( *) 

Ten Persons Charged With Various Drug Violations, from the Seattle 

Times, Nov. 21, 1970, pp. 860 -- — — ( ) 

Man Involved in Drug Sale Sentenced to Prison for 7th Time, from 

the Seattle Times, Mar. 3, 1971, pp. 860-1 ( ) 

•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



VII 

Amphetamine Legislation Hearings, 1971, excerpts from — Continued 

Some Doctors Lax on Drug, from the Seattle Post, May 12, 1971, pp. ?*& 
861 (*) 

Illegal Traffic in Drug Noted, by Judy Ismach, from the Seattle 

Post, May 12, 1971, p. 861 (*) 

Amphetamines a Drug Threat to Children?, by Kathy Parrish, from 

the Detroit News, Mar. 14, 1971, pp. 861-4 (*) 

Drugs That Help Control the Unruly Child, by Robert Reinhold, 

from the New York Times, July 5, 1970, pp. 864-5 (*) 

How Schools Calm "Overactive" Kids, by H. L. Schwartz, from the 

New York Post, Nov. 23, 1970, pp. 865 (*) 

Antipsychotic Agents, Chapter 29, excerpt from AMA Drug Evaluations, 

1971, pp. 231-41 570 

Transfer of Ritalin and Preludin to Schedule II, by Hon. Birch Bayh, 

from the Congressional Record, Oct. 27, 1971 581 

Methadone Poisoning in Children — A Growing Crisis, by Hon. Robert P. 

Griffin, from the Congressional Record, Oct. 27,1971 586 

To Medicate— To Debate— Or To Validate, by Eric Denhoff, M.D., 

from the Journal of Learning Disabilities, November 1971 587 

Drugs in Maladaptive School Behavior, by Kenneth Zike, from symposium 

of Clinical Use of Stimulant Drugs in Children, 5-8 March, 1972 590 

Amphetamines in the Treatment of Hyperkinetic Children, by Lester 

Grinspoon and Susan B. Singer, from Harvard Educational Review, 

Vol. 43, November 1973 (*) 

Ritalin for School Children: The Teacher's Perspective, by Stanley S. 

Rovin and James J. Bosco, from Journal of School Health, Vol. XLIII 

(10)624-8 597 

Hyperactive Child: Are Drugs Answer?, by Andrew Barnes, from the 

Washington Post, Apr. 5, 1973 603 

The Happy Pill — A Model of Child Repression, excerpts from an article 

by John Hurst, and Ann Bernard 605 

Hyperactive Diet: A Doctor's Checklist, by Thomas Grubisich, from the 

Washington Post, Jan. 17, 1974 609 

You May Not Know It, But Your Schools Probably Are Deeply Into the 

Potentially Dangerous Business of Teaching With Drugs, by Ellen 

Bowman Welsch, National School Boards Association, February 1974.-, 611 
Multimodality Treatment of the Hyperkinetic Child, by Anne C. Feighner 

and John P. Feighner, from Am. J. Psychiatry, April 1974 616 

Megavitamin Therapy and Orthomolecular Medicine, by Linda M. 

Johnston, from PharmChem Newsletter, Aug.-Sept. 1975 621 

Learning Disabilities and Delinquent Youth, by August J. Mauser, from 

the Academic Therapy, Summer 1974 624 

Drugging the American Child: We're Too Cavalier About Hyperactivity, 

by Sydney Walker, from Psychology Today, December 1974 638 

A Slavish Reliance on Drugs: Are We Pushers for Our Own Children?, by 

Carole Wade Offir, from Psychology Today, December 1974 643 

Chaining Children With Chemicals, by T. A. Vonder Haar, from the 

Progressive, March 1975 644 

Food Chemicals: Eat, Drink, and be Wary?, by Geraldine Pluenneke, 

fromBusiness Week, Jan. 13, 1975 649 

Hyperactive Children Still in Medical Maze, by Ronald Kotulak, from the 

Chicago Tribune, Apr. 17, 1975 650 

Physician Warns of Dangers in Drugging Children, from the Psychiatric 

News, May 7, 1975 652 

Hyperkinesis and Learning Disabilities Linked to Artificial Food Flavors 

and Colors, by Ben F. Feingold, from American Journal of Nursing, 

May 1975 653 

Methylphenidate and Caffeine in the Treatment of Children with Minimal 

Brain Dysfunction, by Barry D. Garfinkel et al., from the Am. J. 

Psychiatry, July 1975 660 

Order in the Classroom: Drugging for Deportment, by Farnum Gray, 

from The Nation, Nov. 1, 1975 665 



•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



VIII 

Schools Forced Children To Take Drug, Suit Says, by Gary H. McKenzie, ?*& 
from the Los Angeles Times, Sept. 9, 1974 668 

Delbert Benskin, et al. v. Taft City School District et al., Civil Action No. 
136795 in the Superior Court of the State of California in and for Kern 
County, Sept. 8, 1975 668 

Schools Facing Drug Lawsuit, from the Washington Post, Dec. 3, 1975 — 700 

A selected bibliography on the use of Ritalin to control hyperactive 

children 701 

Hyperkinesis, by Irene Lalbin, from the FDA Press Office, Jan. 13, 1976.. 702 

First report of the preliminary findings and recommendations of the 
Interagency Collaborative Group on Hyperkinesis, submitted to the 
Assistant Secretary for Health, U.S. Department of Health, Education, 
and Welfare, 1976 (*) 

Depriving the Best and the Brightest, by Jack Fincher, from Human 

Behavior, April 1976 703 

How Schools Drug Your Children, by Steve Berman, from Science Digest, 

April 1976 709 

Additives and Hyperactivity, by Jean Mayer and Johanna Dwyer, from 

the Baltimore Sun, Aug. 8, 1976 712 

Hyperkinetic Children, by Edith M. Fairman, from Library of Congress, 

CRS Major Issues System, Aug. 16, 1976 713 



•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



CONTENTS 



Volume II 



The Improper Drugging of Mentally 111 and 
Mentally Handicapped Persons 



Page 
Opening statement by Senator Birch Bayh, chairman 1 

CHRONOLOGICAL LIST OF WITNESSES 

Thursday, July 31, 1975 

Lehr, Dennis J., partner, Hogan& Hartson, Washington, D.C 4 

Prepared statement 7 

Ferleger, David, director, Mental Patient Civil Liberties Project, Phila- 
delphia, Pa 163 

Prepared statement 168 

Ellis, James W., staff attorney, Mental Health Law Project, Washington 

D.C 273 

Prepared statement 278 

Marker, Gail, M.S.W., Mental Health Law Project, Washington, D.C_.. 282 

Prepared statement 287 

LIST OF EXHIBITS 

1. From Dennis J. Lehr, Hogan & Hartson, Washington, D.C: 

A — Legal Restrictions on the Use of Phenothiazines in Institutions 
for the Mentally Retarded 14 

B — Letter of July 16, 1974, to Hon. Alexander M. Schmidt, com- 
missioner, Food and Drugs, DHEW 85 

C — Letter of November 26, 1974, to Hon. Alexander M. Schmidt, 

commissioner, Food and Drugs, DHEW, with enclosures 112 

D — Letter of January 30, 1975, to Hogan & Hartson, from Thomas 
A. Hayes, M.D., chief, Psychopharmacology Unit, FDA, DHEW, 
in response to letters of July 16, and November 1, 1974 120 

E — Letter of February 5, 1975, to Hogan & Hartson, from William 
W. Vodra, attorney, Food and Drug Division, DHEW, with 
enclosures 123 

F — Letter of March 10, 1975, to Hogan and Hartson, from Robert 
L. Sprague, Ph.D., director, Children's Research Center, Univer- 
sity of Illinois at Urbana-Champaign 148 

G — Letter of March 26, 1975, to Dr. Robert L. Sprague, director, 
Children's Research Center, University of Illinois at Urbana- 
Champaign 150 

2. Bartley v. Kremens, Civil Action 72-2272 (E.D. Pa.) 175 

3. Souder v. Maguire, Appeal 74-2039 (3d Cir.) 189 

4. Loosing the Chains: In-Hospital Civil Liberties of Mental Patients, 

by David Ferleger, reprint from Santa Clara Lawyer, Vol. 13, 
Spring 1973 230 

5. Patient's Rights — You Mean We Have Some?, a manual for inmates 

of Pennsylvania mental institutions 258 

6. Letter of September 10, 1976, to Hon. Birch Bayh from Peter M. 

Heller of Philadelphia, Pa., regarding forced incarceration in St. 
Elizabeth Hospital and involuntary usage of Thorzaine 273 

(IX) 



List of Exhibits — Continued 

7. Charts on lack of scientific evidence regarding the use of phenothia- Page 

zines with mentally retarded persons, from Gail Marker 292 

8. Letter of August 28, 1975, to Hon. Birch Bayh from Michael A. 

Schwartz, Ph.D., Dean, State University of New York at Buffalo, 
regarding a national clearinghouse for drug information 353 

9. Letter of August 28, 1975, to Hon. Birch Bayh from Warren E. 

Weaver, Dean, School of Pharmacy, Medical College of Virginia, 
Richmond, Va., regarding a national clearinghouse for drug 
information 356 

10. Letter of August 29, 1975, to Hon. Birch Bayh from K. L. Kaufman, 

Dean, Butler University, Indianapolis, Ind., regarding a national 
clearinghouse for drug information 357 

11. Letter of September 11, 1975, to Hon. Birch Bayh from Hector A. 

Lozada, Ph.D., Dean, Colegio de Farmacia, Universidad de Puerto 
Rico, Rio Piedras, P.R., regarding a national clearinghouse for drug 
information 358 

12. Letter of October 1, 1975, to Hon. Birch Bayh from Arthur S. Wata- 

nabe, associate director, Drug Information Service and Anthony 
R. Temple, M.D., director, Intermountain Regional Poison Con- 
trol Center, Salt Lake City, Utah, regarding a national clearing- 
house for drug information, with enclosures 360 

Judgmental questions processed by a drug information center, 

by Marcellus Grace and Albert I. Wertheimer, from Am. J. 

Hosp. Pharm., Sept. 1975 362 

Pharmacist-Manned Drug Information Centers Are Increasing!, 

by Jack M. Rosenberg, et al., from Pharmacy Times, June 

1974 364 

13. Letter of October 7, 1975, to Hon. Birch Bayh from Gary H. Smith, 

Director, Drug Information Service, University of Washington, 
Seattle, Wash., regarding a national clearinghouse for drug infor- 
mation, with enclosure 375 

Drug Information Service for Health Care Professionals, by 
Gary H. Smith, from Northwest Medical Journal, January 
1974 377 

14. Article: Retarded Given "Straightjacket" Drug, by Seth Kantor, 

from the Detroit News, Mar. 16, 1975 380 

15. Article: Drugs Control Retarded in Mississippi Center, by Seth 

Kantor, from the Detroit News, Mar. 23, 1975 382 

16. Article: Reckless Use of Sedatives on Mentally Retarded in State 

Institutions, by Seth Kantor, from the Detroit News, Mar. 26, 

1975 383 

17. Article: Senators Probe Behavior Drugs, by Seth Kantor, from the 

Detroit News, Mar. 31, 1975 384 

18. Article: U.S. Suit To Test Rights for Retarded, by Seth Kantor, from 

the Detroit News, July 27, 1975 385 



APPENDIX 



Part 1 — Mentally Handicapped and Retarded 

Letter of February 6, 1975 to David Tatel of Hogan & Hartson, from 
Thomas A. Hayes, Chief, Psychopharmacology Unit, FDA, DHEW, 
with reference to testimony of Dennis J. Lehr, Exhibit 1A 397 

Food and Drug Administration, Pediatrics Advisory Panel, meeting of 

February 10, 1975 (*) 

Methodology of Psychopharmacological Studies With the Retarded, by 
Robert L. Sprague and John S. Werry, reprinted from International 
Review of Research in Mental Retardation, Vol. 5, pp. 147-219 (*) 

Psychotropic Drugs and Handicapped Children, by Robert L. Sprague 
and John S. Werry, from The Second Review of Special Education, 
JSE Press, Philadelphia, Pa., 1974, pp. 1-50 (*) 



•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



XI 

Letter of Nov. 21, 1975, to Hon. Birch Bayh from Robert C. Wetherell, 

director, Office of Legislative Services, FDA, DHEW, regarding pheno- ' Pa K e 

thiazines in juvenile institutions, with enclosures 399 

Letter of Nov. 11 1975 to Dennis Lehr of Hogan & Hartson in re- 
sponse to petition of July 16, 1974, on behalf of Mental Health 

Law Project 400 

Summary for basis of approval of Mellaril (thoridazine) for Sandoz 

Pharmaceuticals (N DA 11,808) 409 

Letter of May 7, 1976 to Alexander H. Schmidt, Commissioner of Food 
and Drugs, FDA, from Mental Health Law Project; regarding formal 
response of FDA to petition with respect to abuse of phenothiazine 

drugs in institutions for the mentally retarded persons 431 

FDA Petitioned Again To Relabel Drugs for Retarded, from Mental 

Health Law Project newsletter, June 1976 448 

Phenothiazine Drugs Not Iudicated for Mental Retardation, from F-D-C 

Reports, Feb. 17, 1975 448 

All Mental Health Institutions Should Be Contacted by FDA Re. 

Phenothiazine Usage, from F-D-C Reports, Mar. 3, 1975 449 

Notice of Hearings on the Abuse and Misuse of Controlled Drugs in 
Juvenile Institutions, excerpt from the Congressional Record, Mar. 26, 

1975 450 

Pawns in a Pill Game, by Lawrence Mosher, from the National 

Observer, Jan. 11, 1975 - 452 

Letter of January 3, 1975 to Larry Mosher from Craig Burrell, Vice Presi- 
dent, Sandoz, Inc., regarding Mr. Mosher's article on treatment of 

institutionalized mental patients 457 

Retardation Expert Hits Over-Drugging, from Behavior Today, Sept. 8, 

1975 459 

The Mental Health Law Project — Summary of activities : 

March 1975 (*) 

June 1975 (*) 

September 1975 (*) 

Silent Minority, by The President's Committee on Mental Retardation — (*) 
The Foreign Doctor Influx — "It's A National Scandal!", by John H. 

Lavin, from Medical Economics, Inc., Feb. 17, 1969 - 461 

A Bill of Rights for the Handicapped, by Leroy V. Goodman, from Ameri- 
can Education, July 1976, pp. 5, 7-8 -- 467 

Report on a Survey of the Use of Psychopharmacological Agents in 
Massachusetts State Residential Facilities for the Mentally Retarded, 
by Lewis B. Klebanoff, Alberto DiMascio, and Linda M. Lowe, Massa- 
chusetts Department of Mental Health, Boston, Mass., May 1973 470 

Welsh v. Likins [373 F. Supp. 487 (1974)] - 506 

Joint Commission on Accreditation of Hospitals, Accreditation Council 
for Psychiatric Facilities, Chicago, 111.: 

Letter of June 27, 1975, to Thomas A. Piepmeyer, Nevada Mental 

Health Institute 524 

Mental Retardation Program, Nevada Mental Health Institute, 

survey 282075 525 

Letter of April 18, 1975 to Thomas A. Piepmeyer, Nevada Mental 

Health Institute 538 

Nevada Mental Health Institute, survey of Feb. 19-20, 1975 541 

Letter of April 3, 1975, from Charles R. Dickson, administrator, 
Division of Mental Hygiene and Mental Retardation, State of 

Nevada 542 

Report by Robert Plotkin, Mental Health Law Project, Aug. 14, 
1975, regarding Nevada mental retardation systems, with re- 
commendations 544 

Bibliography of Psychotropic Drug Studies in Children and the Mentally 

Retarded 548 

The Retarded Citizen in Quest of a Home, by the President's Committee 
on Mental Retardation, excerpts from, pp. i-v, 1-33, 37-49, 51-59, 
61-69 (*) 



♦Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



XII 

Part 2 — Mentally III 
a. rights of drugged persons 

The Rights of Mental Patients: California's Shocking Neglect, by Susan Page 

Littwin, from Coast, February 1976 577 

Insanity Inside Out, by Kenneth Donaldson, a book review by the Mental 

Health Law Project newsletter 580 

What Are Mental Patients' Rights?, by Jean Dietz, from the Boston 

Globe, Oct. 21, 1975 581 

Mental Health Legislative Guide, final draft to be critiqued, Mental 

Health Law Project, Washington, D.C 584 

Forced Drug Medication of Involuntarily Committed Mental Patients, 
by Norman R. Blais, from the St. Louis University Law Review, Vol. 

20, 1975, pp. 100-119 614 

Arizona Law Review, Vol. 17, No. 1, 1975: 

Viewpoints on Behavioral Issues in Closed Institutions ; Introduction _ 634 
Behavioral Modification in Institutional Settings, by Teodoro 

Ayllon 636 

Institutional Behavioral Modification as a Fraud and Sham, by 

Edward M. Opton, Jr 653 

New Words for an Old Power Trip : A Critique of Behavioral Modi- 
fication in Institutional Settings, by Janet Gotkin 662 

Behavioral Modification in Institutional Settings: A Critique, by 

Joseph G. Perpich - 666 

Legal Regulation of Applied Behavior Analysis in Mental Insti- 
tutions and Prisons, by Raul R. Friedman 672 

Singling Out Behavior Modification for Legal Regulation: Some 
Effects on Patient Care, Psychotherapy, and Research in General, 

by Israel Goldiamond 738 

Proposed Legal Regulation of Applied Behavior Analysis in Prisons: 

Consumer Issues and Concerns, by Rudi Clemons 760 

Reflections on the Legal Regulation of Behavior Modification in 

Institutional Settings, by David B. Wexler _- 765 

Toward a Constructional Approach to Social Problems, by Israel Goldia- 
mond, from Behaviorism, Vol. 2, No. 1, Spring 1974 (*) 

Legislating the Control of Behavior Control: Autonomy and the Coercive 
Use of Organic Therapies, by Michael H. Shapiro, from the Southern 

California Law Review, Vol. 47, No. 2, February 1974, pp. 237-356 777 

Volunteering Children: Parental Commitment of Minors to Mental 
Institutions, by James W. Ellis, from the California Law Review, 

Vol. 62, No. 3, May 1974, pp. 840-916 897 

In re Michael E., [538 P. 2d Cal. (1975)] 974 

Right to Treatment — California, from Juvenile Court Digest, December 

1975 -- 981 

Ruling on Confining Mentally 111 Argued, by Boyce Rensberger, from the 

New York Times, Aug. 18, 1975 981 

O'Connor v. Donaldson, No. 74-8: Supreme Court Opinions announced 

June 26, 1975 983 

Federally Funded Illegal Drug Experiments Performed on Psychiatric 
Patients, letter of Sept. 2, 1975, to Hon. Birch Bayh, from Wolfram & 
Wolfram, P.C., attorneys at law, New York, N.Y 1000 

B. THE DRUGGED MENTALLY ILL 

Abuses Charged in Mental Wards, by Murray Schumach, from the New 

York Times, Mar. 13, 1975 !027 

Mental Patients Said "Overdosed, " by Robert Johnson, from the Tampa 

Tribune, June 13, 1975 !028 

Drugged Patients Said Treated for Disease, by Robert Johnson, from the 

Tampa Tribune, June 14, 1975 -- !029 

Chattahoochee Drug Abuse Unconfirmed, by Robert Johnson, from the 

Tampa Tribune, July 10, 1975 iO" 30 

Doctors Plan In-Depth Drug Therapy Study, by Robert Johnson, from 

the Tampa Tribune, July 29, 1975 1031 



•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



XIII 

Odd Man Out — Illinois Mental Health Care, series of articles from the 

Daily Courier-News, Elgin, 111., April 1975: Page 

Mental Health Series — In Search of Sanity 1 032 

System Places Patient Release Over Care, Cure 1033 

ESH Population Reduction Is Objective in the '70s 1035 

Drugs Used To Control ESH Patients 1036 

Caregivers at Elgin State Hospital 1037 

Staff Treats Before Training 1039 

EHS Personnel "Inferior" to Downstate Staffs 1040 

The "Innovators": Are They Victims of Hospital System? 1041 

Workers Cite Staff Shortages, Fear of Harassment for Talking 1042 

Patients Set Free To Sit, Await Death 1042 

Hotel Douglas Provides Haven 1044 

"Queen" Tells a Woman: Why Not Sell Yourself? 1045 

Rapists, Murders and Child Molesters — The System Throws the 

Doors Wide Open 1046 

In 1973 Work Spread Quickly About Elgin Township Aid 1047 

Millions of Tax Dollars Go For All But Patient Housing 1048 

Elgin Aftercare Facilities Poor; "People Are Lost in the Cracks" 1049 

Wanted: One "Right" Formula 1051 

Mental Health Series Draws Comments, Letters 1053 

Controls On Use Of Psychotherapeutic Drugs And Improved Psychiatrist 
Staffing Are Needed In Veterans Administration Hospitals, report to 
the Congress by the Comptroller General of the United States, April 

18, 1975 (*) 

Potentially Dangerous Drugs Missing In VA Hospitals — Different 
Pharmacy System Needed, report to the Congress by the Comptroller 

General of the United States, Sept. 30, 1975 (*) 

Department of Hospitals and Institutions, Santa Fe, New Mexico, 
Sept. 12, 1974: 

DHI Rule 1-74: Handbook on procedures for commitments to State 

institutions 1060 

DHI Rule 2-74: Regulations of the Department of Hospitals and 
Institutions to assure humane care and treatment of patients and 

the protection of patients rights 1085 

Halderman v. Pennhurst Stale School and Hospital: Civil Action No. 

74-1345, U.S. District Court, E.D. Pa 1110 

Institutional Peonage — Our Exploitation of Mental Patients, by F. Lewis 

Bartlett, M.D., from the Atlantic Monthly, July 1964 1180 

Maintenance Psychotropic Drugs in the Presence of Active Treatment 
Programs, by Gordon L. Paul, Lester L. Tobias, and Beverly L. Holly, 

from Arch Gen Psychiat/Vol 27, July 1972 1184 

Antipsychotic Agents, Chapter 29, from AMA Drug Evaluations, 1971, 

pp. 231-41 1195 

Drugs Forced on Patients, Three Aides Say, by B. D. Colen, from the 

Washington Post 1206 

Treatment of Women Patients, from Mental Health Law Project news- 
letter 1207 

Women in the Hospital, from Mental Health Law Project newsletter 1207 



•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



CONTENTS 



Volume III 

Formerly Institutionized Persons and Physicians; Mental 
Health, Mentally Handicapped and Criminal, Juvenile 
Justice Systems 

Page 
Opening statement by Senator Birch Bayh, chairman 1 

CHRONOLOGICAL LIST OF WITNESSES 

Monday, August 18, 1975 

Panel of formerly institutionalized persons : 

Gotkin, Janet, Croton-On-Hudson, N.Y 4 

Prepared statement 13 

Brandt, Anthony, author/ journalist, Shrub Oak, N.Y 17 

Prepared statement 24 

Lennox, Craig, of Pasadena, Calif 27 

Hudson, Wade, Network Against Psychiatric Assault, San Francisco, 

Calif 31 

Prepared statement 35 

Chamberlin, Judi, of Bellingham, Wash 86 

Prepared statement 89 

Lamere, Tony, of Great Falls, Mont 97 

Panel of medical experts: 

Kaufman, Dr. Edward, M.D., medical director, Lower Eastside Service 

Center, New York, N.Y 103 

Clements, Dr. James, M.D., director, Georgia Retardation Center, 

Atlanta, Ga 111 

Prepared statement 119 

Wendel, Dr. Herbert A., M.D., associate professor of pharmacology and 

head, Division of Clinical Pharmacology, Health Services Center, 

University of Oregon, Portland, Oreg 127 

Prepared statement 130 

LIST OF EXHIBITS 

1. Advertisement: Too Much Anger, Too Many Tears, by Janet and 

Paul Gotkin, The New York Times Book Co 6 

2. Advertisement: Reality Police — The experience of insanity in America, 

by Anthony Brandt, William Morrow Co _ — ._ 18 

3. Miscellaneous personal testimony, from Network Against Psychiatric 

Assault 39 

4. Summary of the Agnews Project, Rappaport, Silverman, et al 59 

5. Excerpt: Towards an Enlightened Commitment Law, based on a study 

of psychiatric institutions, especially St. Elizabeth's Hospital, 
Washington, D.C 62 

6. Are We Pushers for Our Own Children?, from Psychology Today, 

Dec. 1974, p. 49 64 

7. Drug Environment/Drugged Environment, from The Cure, Madness 

Network News, pp. 101-21 65 

8. Article: Mental Clan Angry — They Want Lib, Too, by Judi Chamberlin, 

from the State Journal, Jan. 15, 1976 92 

9. Article: Senate Is Told of "Warehouses" for Retarded, by Gary 

Blonston, from the Charlotte (N.C.) Observer, Aug. 1, 1975 135 

(XV) 



XVI 

Lists of Exhibits — Continued 

10. Article: Drugging and Shipping of Troubled Children Challenged, by ^age 

Clayton Jones, from the Christian Science Monitor, Aug. 6, 1975 136 

11. Article: Ex-Mental Patients Tell of Drugging, by Cynthia Gorney, 

from the Washington Post, Aug. 19, 1975 137 

12. Article: Inmates Called "Tamed" by Dope, by Seth Kantor, from the 

Detroit News, Aug. 19, 1975 137 

13. Article: Careless Use of Mental Drug Charged, by William Hines, 

from the Chicago Sun-Times, Aug. 19, 1975 138 

14. Article: Institutions Criticized In Use of Drugs, by Judith Randal, 

from the New York News, Aug. 19, 1975 139 

15. Article: Chemical Straitjacket Victims Rap Institutions' Drug Use, 

from the Baltimore News American, Aug. 19, 1975 140 



APPENDIX 



Part 1 — Mental Health and Handicapped Abuses 

Poe, Roe, and Doe v. Weinberger, Brown, and Robinson, Civil Action 

74-1800, filed Dec. 10, 1974, in the U.S. District Court for the District P a s e 
of Columbia ---- 145 

Mental Health and Law: A System in Transaction, by Alan A. Stone, 

M.D., National Institute of Mental Health, Rockville, Md (*) 

Letter of Aug. 19, 1975, to Hon. Birch Bayh from Margaret G. Kint, with 

enclosure "What Is Schizophrenia?" 151 

Part 2 — Juvenile Justice Abuses 

Letter of November 21, 1975, to Hon. Birch Bayh from Alexander Satin of 
Sherman Oaks, Calif., with enclosure of article from the Los Angeles 

Times entitled "Probe Ordered Into DrUgs for Juveniles" 153 

Recommendations for Improving the Quality and Appropriateness of 
Physical and Mental Care of Detainees, April 8, 1976, County of Los 

Angeles, Department of Health Services, L. A. Witherill, director 155 

Health Care Provided Juveniles in Probation Department Facilities, 
Nov. 26, 1975, Chief Administrative Officer, County of Los Angeles, 

Harry L. Hufford 157 

Prisons, Adolescents, and the Right to Quality Medical Care, by Ins F. 
Litt, M.D. and Michael I. Cohen, M.D., from AJPH September, 1974, 

Vol. 64, No. 9, pp. 894-7 I 61 

Health Delivery to Detained Adolescents, by I. F. Litt, M.D., Albert 

Einstein College of Medicine, Montefiore Hospital, New York, N.Y.. 165 
Health Care for Juveniles on Probation, by S. Kenneth Schonberg, M.D., 
Albert Einstein College of Medicine, Montefiore Hospital, New York, 

N Y 1^5 

Center for Boys Is Cited by Court, by Arnold H. Lubasch, from the New 

York Times, June 1974 I 66 

Letter of August 6, 1975, to John M. Rector, chief counsel, Senate Sub- 
committee To Investigate Juvenile Delinquency from Mara T. Thorpe, 
Legal Aid Society, Juvenile Rights Division, Brooklyn, N.Y., with 

enclosures - 100 

Excerpts of trial transcript Pena v. New York State Division for 
Youth (S.D.N. Y. 70 Civ. 4868) with summary of the evidence on 

use of thorazine 1/0 

Preliminary statement from the post-trial memorandum 221 

Stipulation in Pena (paragraphs 30 and 31 relating to use of 

thorazine) 224 

Medical regulations prior to Pena trial 227 

Medical regulations subsequent to Pena trial 228 

Excerpt of transcript in Nelson v. Heyne relating to use of thorazine. 229 

•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



XVII 

Part 3 — Criminal Justice Abuses 

Development and Legal Regulation of Coercive Behavior Modification 

Techniques With Offenders, by Ralph K. Schwitzgebel, National ?*& 
Institute of Mental Health, Chevy Chase, Md., February 1971 234 

Psychedelic Drugs in Correctional Treatment, by D. F. Duncan, from 

Crime and Delinquency, July 1972 330 

Conditioning and Other Technologies Used To "Treat?" "Rehabilitate?" 
"Demolish?" Prisoners and Mental Patients, from Southern California 
Law Review, Vol. 45, pp. 616-81 (*) 

Prisoners' Rights in Prison Medical Experimentation Programs, by John 
Bowers, from the Clearinghouse Review, Vol. VI, No. 6, October 1972, 
pp. 319-33 339 

City Jail Scored on Tranquilizers, by Ronald Smothers, from the New 

York Times, Dec. 24, 1972 354 

Experiments Behind Bars, by Jessica Mitford, from The Atlantic Monthly, 

January 1973, pp. 64-73 356 

Token and Taboo: Behavior Modification, Token Economies, and the 

Law, by David B. Wexler [61 Calif. L. Rev. 81 (1973)] 366 

Knecht v. Gillman [488 F. 2d 1136 (1973)] 383 

Hiding the Tough Prison Cases?, from the Christian Science Monitor, 

Jan. 25, 1974 389 

The Pacification of the Brain, by Stephen L. Chorover, from Psychology 

Today, May 1974, pp. 59-69 390 

From the American Criminal Law Review, Vol. 13, No. 1, Summer 1975: 

Table of contents 399 

Behavior Modification in Prisons, by Willard Gaylin and Helen 

Blatte, pp. 11-35 400 

Bibliography — Behavior Modification: An Overview, pp. 101-13 425 

Behavior Modification Programs: The Bureau of Prisons' Alternative to 
Long-Term Segregation, Department of Justice, by the Comptroller 
General of the United States, Aug. 5, 1975 (*) 

Behavior Modification, by Edgar H. Brenner, reprint from Release 12 of 

Criminal Defense Techniques, 1976, Sec. 73-1 through Sec. 73-07 (*) 

Part 4 — Drug Traffic and Abuse in Criminal 
Justice Institutions 

Prisoners as Laboratory Animals, by Michael Mills and Norval Morris, 

from Society, July- August, 1974, pp. 60-66 439 

Drug Histories of Prisoners — Survey of Inmates of State Correctional 

Facilities, by William I. Barton, Apr. 5, 1976 447 

Indiana Boys' School — Maximum Security Unit, 1975 455 

Drug Tests in Prisons Deplored, from the Bremerton (Wash.) Sun, Aug. 7, 

1969 458 

Why Not Use Prisoners To Find Out About Marijuana?, By William F. 

Buckley, Jr., from the Los Angeles Times, Feb. 9, 1970 459 

Drugs, Prison Change Ex-Students' Lives, from the Chicago Tribune, 

Mar. 15, 1970 460 

U.S. Prisons Attempt Behavior Modification, by David Patz, from the 

Minneapolis Freeworld Times, January 1973 461 

Sixty Percent of Inmates Say They Used Drugs, from the New York Times, 

Apr. 25, 1976 463 

Drugs, Crime Linked, an editorial, from the Terre Haute (Ind.) Tribune, 

May 6, 1976 464 

Sixty-One Percent of Prisoners Have Used Drugs, from the New York 

Times, June 2, 1976 464 

Mental Care Plan Probed, by Stuart Auerbach, from the Washington Post, 

July 22, 1974 465 

Canadian Prison Guard Busted With $6 Million in Heroin, from Corrections 

Digest, Apr. 2, 1975 466 

•Cited materials to be found in the files of the Subcommittee To Investigate Juvenile 
Delinquency, Committee on the Judiciary, U.S. Senate. 



33-303 O - 77 - 2 



XVIII 

Ethnic Gangs Rampant in California, by Steve Casey, from the San Diego P a s e 

Evening Tribune, Feb. 2, 1973 466 

Special Panel To Decide Issue of Youth in Prisons, from the San Francisco 

Chronicle, June 21, 1975 468 

Drug Probe at Quentin Narrows, from the San Francisco Chronicle, Jan. 

21, 1975 469 

Suspected Drug Thefts, Abuse Target of Probe, by Cindy Parmenter, from 

the Denver Post, Mar. 23, 1975 469 

Prison Questions for Gov. Brewer, from the Adviser-Journal, August 1969 _ . 470 
Dodd Says Prisons Spread Use of Drugs, from the New London (Ct.) Day, 

Sept. 29, 1969 471 

Drugs in Prison, an editorial, from the Baltimore News American, Nov. 9, 

1969 472 

Link Five Guards, 20 Pushers to Dope Traffic at Jessup, by Ray Gill, 

from the Baltimore News American, Nov. 11, 1969 472 

Drugs Behind Bars, an editorial, from the Baltimore News American, Nov. 

12, 1969 474 

Dope Probe Easing Asked by Cannon, by Ray Gill, from the Baltimore 

News American, Nov. 19, 1969 474 

Rep. Gude Tours Homes for Convicts, Addicts, by Martin Weil, from the 

Washington Post, Nov. 22, 1969 475 

Correction Chief Cannon Defended by Drug Addict, by Ray Gill, from the 

Baltimore News American, Nov. 24, 1969 476 

Inmates Phone for Dope?, from the Washington Daily News, Dec. 8, 1969. _ 477 
Jail Drug Patrols Asked, by Jonathan Cottin, from the Washington Daily 

News, Dec. 9, 1969 477 

Ex-Cons Ask Pot Penalty Be Eased, from the Washington Daily News, 

Jan. 17, 1970 478 

Anti-Narcotics Play Not Fiction to Prison Audience, by Michael Olesker, 

from the Baltimore News American, July 12, 1970 478 

Marijuana Thrives on Jail Grounds, by Douglas Watson, from the Wash- 
ington Post, July 14, 1970 479 

Guards Guilty of Selling Drugs, from the Washington Post, Jan. 17, 1971... 480 
Inmate's Death Sparks Lorton Drug Search, by Walter Tavlor, from the 

Washington Evening Star, Aug. 21, 1971 . 480 

Drug Use Admitted at Cedar Knoll, by J. Y. Smith, from the Washington 

Post, Feb. 8, 1972 481 

Lorton Inmate Dies in Cell of Drug Overdose, by William L. Claiborne, 

from the Washington Post, Nov. 17, 1972 481 

Prisoner Saved After Overdose, by Paul Hodge, from the Washington Post, 

Nov. 20, 1972 482 

Study Finds Drugs, Sex in Maryland Youth Centers, from the Washington 

Evening Star, Jan. 14, 1974 483 

Police Assist Probe, by Charles Hardy, from the Washington Evening Star, 

Mar. 3, 1974 484 

Drugs Cited in Two Deaths at Boys Village, by Judy Luce Mann and Bill 

Richards, from the Washington Post, Mar. 3, 1974 484 

Darvon Pills Believed Missing From Infirmary of Boys Village, by Charles 

A. Krause, from the Washington Post, Mar. 4, 1974 487 

Fatal Pills May Have Come From Village Infirmary, from the Washington 

Evening Star, Mar. 4, 1974 488 

D. C. Hospital Drug Thefts Probed; Nurse Arrested, bv Judy Luce Mann, 

from the Washington Post, July 18, 1975 488 

D.C. Doctor Appalled at Drug Thefts From Hospital, from Narcotics Con- 
trol Digest, July 23, 1975 489 

Across the States — Florida, from Corrections Digest, Feb. 25, 1976 490 

Warden Says 50 Rioters Used Drugs, from the Washington Evening Star, 

Aug. 11, 1971 490 

Looting, Drug Sales Alleged, by Art Petacque, from the Chicago Sun- 
Times, Oct. 25, 1970 490 

Proloxin, from the Minneapolis Freeworld Times, March 1972 492 

Inmate- Guard Drug Ring Is Smashed, by Bob McClure, from the Gary 

(Ind.) Post Tribune, Oct. 18, 1969 492 

Eighty Percent of Women Inmates Drugged, State Board Told, by Byron 

C. Wells, from the Indianapolis Star, Mar. 21, 1975 493 



XIX 

Bovs School Inmates Sue for $1.7 Million, from the Indianapolis Star, T" 8 ^ 

June 1 3, 1975 494 

Reveal Boys School Drug Abuse, bv Byron C. Wells, from the Indianapolis 

Star, June 13, 1975 494 

Racial Fights, Drugs, Sex Plague Juvenile Center, by Bob Hetherington, 

from the Indianapolis News, June 25, 1975 495 

Young Inmates Lack Work, by Laura Scott, from the Kansas City (Mo.) 

Star, July 12, 1973 496 

Quantity of Drugs Has "Disappeared' 1 at Penitentiary, by John Filiatreau, 

from the Louisville Courier-Journal, Mar. 17, 1974 498 

State Corrections Chief Assails Prison Drug Story, by Bill Powell, from the 

Louisville Courier-Journal, Mar. 20, 1974 506 

House Asks Study of Drugs in Prisons, from the Louisville Courier- 
Journal, Mar. 20, 1974 509 

Drugs at Eddyville: The Bigger Issue, an editorial, from the Louisville 

Courier-Journal, Mar. 22, 1974 510 

Panel To Investigate Drug Irregularity Reports at Penitentiary, by John 

Filiatreau, from the Louisville Courier- Journal, Mar. 26, 1974 511 

Prison Probe: Too Bureaucratic and Too Narrow, from the Louisville 

Courier-Journal, Mar. 29, 1974 512 

Kentucky Prisons Get Tough New Drug Control Procedures, from Nar- 
cotics Control Digest, Nov. 20, 1974 512 

Holmes Answers Allegations of Prison Drug Abuse, from Narcotics Control 

Digest,Feb. 12, 1975 513 

Kentucky Prison Drug Rules Strictly Enforced, Chief Says, from Nar- 
cotics Control Digest, Feb. 19, 1975 514 

Report Alleges Prison Operated Improperly, by Don Walker, from the 

Louis.ille Courier-Journal, Feb. 20, 1975 516 

Holmes and Cowan Declare Committee Was "One-Sided" in Penitentiary 

Probe, by Don Walker, from the Louisville Courier-Journal, Feb. 21, 

1975 517 

Prison To Write Policy on Drugs, from the Jefferson City (Mo.) Post- 
Tribune, Mar. 6, 1975 519 

Pen "Can't Shut Off Drug Influx", by Michael Holmes, from the Omaha 

World Herald, July 10, 1975 519 

Drug Flow Is Heavy in Prison, by John Toth, from the Trentonian (N.J.), 

Dec. 11, 1974 520 

"Swag" Dealing Is Big Jail Pastime, by John Toth, from the Trentonian 

(N.J.),Dec. 11, 1974 524 

Probe Begun in Addict Jail Suicide, by John Mullane, from the New York 

Times,Nov. 19, 1969 527 

Addict Ends Life at Rikers Island, from the New York Times, Nov. 23, 

1969 527 

Jailed Victim— Turned On and Tuned Out, by Christopher Williams, from 

the New York Post, Feb. 21, 1970 528 

Jailer Held on Pot Rap, from the New York Post, Mar. 7, 1970 528 

Investigation Reveals Liquor, Narcotics, Women Supplied to N.Y. 

Inmates, from the Minneapolis Freeworld Times, January 1973 529 

Four City Jail Aides Indicted Here, by David Burnham, from the New 

York Times, Dec. 7, 1973 529 

"In Darkness, and With Dangers Compass'd Round," by Hortense W. 

Gabel, from the New York Times, May 7, 1975 530 

Overcrowding Increases Prison Tension, by Alphonso Narvaez, from the 

New York Times, Aug. 2, 1975 533 

Drug Laws Cited at a State Hearing on Prison Unrest, from the New York 

Times, Sept. 1, 1976 535 

Death of Inmate Spurs D.A. Probe of Heroin Traffic in City Prisons, by 

Dave Racher, from the Philadelphia Daily News, Feb. 9, 1970 536 

Wide Use of Drugs in Prison Denied, by James H. Laverty, from the 

Philadelphia Evening Bulletin, Feb. 10, 1970 537 

Prison Asked for Addicts Refusing Aid, from the Philadelphia Evening 

Bulletin, Mar. 12, 1970 537 

Scandals Plague Graterford Officials, from the Minneapolis Freeworld 

Times, January 1973 538 



XX 

Guard Found With Heroin, from the Minneapolis Freeworld Times, P a & e 
May 1973 539 

Prison Smuggling, by Jack Anderson and Les Whitten, from the Washing- 
ton Post, Aug. 2, 1975 539 

Inmates Deaths Bring Call for ACI Probe, from the Providence Journal, 
July 8, 1975 540 

Problems Enough at ACI, an editorial, from the Providence Journal, 
July 13, 1975 540 

Would Stemming Contraband Flow Ignite Prisons?, by Paul Giacobbe, 

from the Providence Journal, July 20, 1975 541 

Drug Council Questions Prison Study, by Ron Winslow, from the Provi- 
dence Journal, Oct. 3, 1975 542 

Reformatory Drug Use Poses Quandary, from the Seattle Times, Aug. 27, 

1975 543 

Influx of Drug Offenders Cited for Improved Jails, from the Charleston 

(W. Va.) Mail, Sept. 24, 1974 544 



DRUGS IN INSTITUTIONS 

The Abuse and Misuse of Controlled Drugs in Institutions 

Volume III 

Formerly Institutionalized Persons and Physicians; Mental 
Health, Mentally Handicapped and Criminal, Juvenile Jus- 
tice Systems 



MONDAY, AUGUST 18, 1975 

U.S. Senate, 
Subcommittee To Investigate Juvenile Delinquency, 

Committee on the Judiciary, 

Washington, D.C. 

The subcommittee (composed of Senators Bayh, Hart, Burdick, 
Kennedy, Mathias, Hruska, and Fong met. pursuant to notice, at 
10:20 a.m., in room 2228, Dirksen Senate Office Building, Senator 
Birch Bayh (chairman of the subcommittee) , presiding. 

Present : Senator Bayh. 

Also present : John M. Rector, staff director and chief counsel and 
Mary Karen Jolly, editorial director and chief clerk. 

Senator Bayh. We will reconvene our hearings on drugs in in- 
stitutions this morning. 

Let me, for the sake of our witnesses, as well as others who may not 
have been following this issue as closely as some, skim over some in- 
troductory remarks that I have prepared this morning. 

OPENING STATEMENT OF SENATOR BIRCH BAYH, CHAIRMAN 

Senator Bayh. This morning we continue our series of hearings re- 
garding drug abuse in adult and juvenile institutions with a particular 
focus on the improper use of drugs to control and discipline institu- 
tonalized persons. The subcommittee investigation is based on the view 
that drug abuse, is not limited to unauthorized use by inmates or pa- 
tients, but also includes the administration of mind-controlling drugs 
to unwilling, competent persons and the unnecessary use of these 
powerful medications on those institutionalized. 

Throughout the subcommittee's investigations of the juvenile justice 
system and the enforcement of Federal drug control statutes we fre- 
quently uncovered problems involving the use of dangerous drugs 
to control or discipline persons, particularly youths in a broad spec- 
trum of settings. 

In the landmark cases of Morales v. Turman in Texas, for example. 
Nelson v. Heyne in Indiana, involving the important issue of the 

(l) 



right to treatment in the juvenile justice system it was found that 
phenothiazines — major tranquilizers — were used indiscriminately to 
control the behavior of children who were neither mentally ill nor 
emotionally disturbed. In these cases drugs were administered on the 
advice of custodial staff, with little or no guidance or involvement of 
medical personnel and often under a standing order to use as necessary. 
In one instance a youngster was given a powerful tranquilizer shot 
to prevent him from running away. Such practices were found by the 
courts to be violative of the 8th and 14th amendments as constituting 
cruel and unusual punishment. 

Similarly, so-called "aversion therapy"' or Pavlovian conditioning 
used in a Midwest institution where nonconsenting mental patients 
were forced to take apomorphine, which induced protracted vomiting, 
for violation of minor institutional rules, violates constitutional pro- 
tections. Such substandard and oppressive practices are the subject 
of the subcommitees investigation. 

Likewise, such psychotropic drugs are being used to control the 
conduct of institutionalized mentally retarded persons, both within the 
juvenile justice system and in other settings. The most recent survey 
of these issues, conducted by the National Institute of Mental Health, 
NIMH, in 1970 found that 50 percent of the residents in State and 
private institutions for the retarded were being administered psycho- 
tropic drugs, with more than 25 percent for indefinite duration. 

Last year the subcommittee initiated a special investigation of these 
distressing problems and in the coming months will continue with a 
comprehensive assessment of the practices which lead to the chemical 
strait jacketing of thousands. 

At our initial hearing testimony from the Department of Justice 
officials, social scientists and lawyers vividly portrayed the growing 
practice of using powerful mind-shackling psychotropic drugs to 
control dependent, neglected, disturbed, and mentally retarded per- 
sons. Especially emphasized was the interstate shipment and place- 
ment of children in substandard profitmaking facilities, some little 
more than commercial jails, where they were excessively sedated. 
We cannot sit by and let children in this Nation, because they are with- 
out parents, or troubled, or handicapped be boxed up, shipped off and 
held captive with medical or chemical handcuffs. 

I have asked the Department of Justice to conduct a thorough in- 
vestigation and present a comprehensive report and recommendation 
on these and related problems which we expect will provide, in part, 
the basis for legislation directed at such gross abuses of basic civil 
rights and liberties. 

We are not concerned about those situations where these drugs are 
used appropriately after proper diagnosis, but with the use of such 
drugs without regard to psychiatric or medical diagnosis or the pres- 
ence of approved indications which would justify such usage. We are 
concerned by our preliminary findings that unqualified medical staff 
and even nonmedical personnel may be dispensing and administering 
drugs in violation of the Controlled Substances Act. We are concerned 
about the quality of care available to institutionalized persons and 
shocked to learn that institutions throughout the country may be per- 
mitting the indiscriminate use of dangerous drugs for the sole pur- 
pose of controlling the conduct of those institutionalized and easing 
the management problems of understaffed institutions. 



We are concerned about the use of potentially harmful tranquil- 
izers — chemical straitjackcts as it were, which assure solitary confine- 
ment of the mind — as a substitute for humane treatment and quality 
programs. 

We need to learn more about the serious long-term impact of pheno- 
thiazines. I noted with extraordinary interest that these drugs, along 
with LSD, were the subject of experiments at the now notorious Army 
medical research facility at Edgewood Arsenal in Maryland. I am 
not aware of the design of these studies, or whether those recruited 
to volunteer for the program were informed of the serious risk in- 
volved in taking these drugs. Likewise, phenothiazines were reportedly 
used to drug refuges who protested immigration to the United States. 
In the course of our investigation, I intend to make a full and com- 
plete assessment of these concerns. 

DRUG AVAILABILITY IN CORRECTIONAL FACILITIES 

The other phase of our investigation, but clearly a related concern, 
involves an assessment of the extent to which drugs, legal and illegal — 
heroin, cocaine, amphetamines, tranquilizers, barbiturates, LSD — are 
readily available to addicts and abusers in detention centers, lockups, 
jails and other correctional facilities on the Federal, State, and local 
levels. As ironic as it is many experts and others who have had experi- 
ence with such institutions have found that in some institutions 
youngsters have never had a better source of supply for illegal drugs 
and, in fact, are better able to sustain their habits and abuse patterns 
in the institutions. We are extremely interested in learning more about 
this phenomenon, but especially more about the extent to which diver- 
sion of legitimate drugs on hand and available in juvenile institutions 
are diverted for illegal purposes and abuse. 

Thus, this investigation which we started last year, couples our 
earlier, and ongoing, work regarding the illegal and improper uses of 
controlled drugs with that of our concern about the quality of care 
available to children and others who are institutionalized. 

Today, as we proceed with our inquiry, we are especially gratified to 
several individuals who have consented to sharing their personal ex- 
periences involving institutional drug abuse. Additionally, we welcome 
three nationally known medical experts who will discuss such abusive 
practices as well as what can be done to curb them. 

As we proceed with this series of hearings we will hear testimony 
on all relevant issues. They are problems that are not amenable to 
simplistic solutions. The subcommittee and the American people, how- 
ever, deserve to be fully informed about conditions in our public and 
private institutions, especially those receiving Federal moneys. I am 
optimistic that our witnesses will help to provide the necessary insight. 
I look forward to productive and informative hearings so that all of 
us can better understand the scope of drug abuse and develop sound 
national policies and practices in this area. 

Let me conclude the introduction by saying that the country has 
become alarmed at the amount of drug abuse which exists on the 
streets of our society. We have enacted a whole series of laws, and 
indeed, this committee is pursuing how we can more effectively prohibit 
that kind of drug abuse. 



It seems to be an even sadder circumstance to recognize that, in fact, 
a number of citizens of this country who are ill — both young and old, 
and who have either voluntarily submitted themselves to treatment in 
our mental institutions or have been committed there by the courts of 
this land — have received instead of treatment, a different type of drug 
abuse. Drugs not intended for treatment, but drugs intended merely 
to make the custodial job easier. This business of applying what I 
think can accurately be characterized as mental handcuffs to patients 
to mentally restrict their ability to get up and walk around is as 
horrendous as the previous examples of children actually being hand- 
cuffed by metal handcuffs. 

In those instances in our institutions where drugs have been used not 
to treat but merely to mentally incapacitate, I find intolerable. 

We have with us this morning some individuals who have been 
in various institutions. I am hopeful that they will be very frank 
with us, in sharing their experience, as to whether they were sub- 
jected to any of this kind of drug abuse. If not, we want them to be 
equally frank. We are not witch hunting; we are trying to find out the 
dimensions of this problem, so that we will have a better opportunity 
to know how to come to grips with it. 

We have with us this morning Janet Gotkin, Anthony Brandt, 
Craig Lennox, Wade Hudson, Judi Chamberlin, and Tony Lamere. 
We appreciate all of you being here. 

I suppose the best way to deal with this is to start from left to right, 
if you have no objections. Janet, why do not each of you give us a 
brief summary of your experience, if you will. 

PANEL OF FORMERLY INSTITUTIONALIZED PERSONS 
STATEMENT OF MS. JANET GOTKIN, CR0T0N-0N-HUDS0N, N.Y. 

Ms. Gotkin. My name is Janet Gotkin. I am an ex-mental patient. 
At present I am coordinator of a group called Mental Patients Re- 
sistance, which is a group of ex-mental patients — largely ex-mental 
patients, some very few professionals, and some lay interested people, 
like yourselves. We are part of a national movement, mental patients 
movement, whose thrust is basically political. Our activities in the past 
few years have been involved in exposing the type of things we are 
talking about today, what we consider to be fraudulent and exploita- 
tive actions on the part of psychiatrists. 

And I am particularly gratified to be here today and have a chance 
to speak about my own experiences. I wanted to say initially that my 
only expertise comes from my experience as what I can only cate- 
gorize as a psychiatric guinea pig, in a sense. But I think it is com- 
pelling experience, and it can be validated by thousands and thousands 
of other people throughout the country. It is not in any way an in- 
dividual experience. I think what is outstanding about what I went 
through is that I am here today, that I am not immobilized in the back 
Avards of a hospital. 

I had what Irvin Gothman called a career as a mental patient for 
10 years. During that time, I was in mental hospitals for a total of 
perhaps 3 1 /* years, both private and public hospitals. T had over 100 
electroshock treatments, and what my husband and I estimate, al- 



though there is no — since my records were not available to me — 
something in excess of 1 million milligrams of tranquilizers. 

Senator Bayii. You say your records are not available to you even 
now ? 

ATTEMPTS FOR ACCESS TO PERSONAL RECORDS 

Ms. Gotkix. My husband and I wrote a book 1 about our experiences 
with psychiatry, and after we signed the contract, I wrote to the hos- 
pitals in which I was incarcerated, and requested access to my records. 
They refused, and the Mental Health Law Project handled the case 
in which I sought access to my records. We lost the case, and we lost 
the appeal, so at present, my only way of access to those records would 
be through a psychiatrist, or through a physician. I have not chosen, 
as yet, to take that tack. Possibly I will in the future. 

The book was written without the help of the records. 



1 See Exhibit No. 1. 



6 



[Exhibit No. 1] 



TOO MUCH ANGER, 
TOO MANY TEARS 



A Personal Triumph 
over Psychiatry 

Janet & Paul Gotkin 

The odyssey of a descent into the hell of mental illness— 
and of a miraculous recovery— in spite of psychiatry. Too 
Much Anger, Too Many Tears is the story of too much hurt- 
ing and too tittle help. But it is also the story of a love that 
endured— the love of Janet and Paul Gotkin. 

Janet was a mental patient for ten years. And for ten years 
she underwent the humiliation and dehumanization that 
masquerades as psychiatric treatment During that time, 
'she met and married Paul, who stood by— his hands out 
td*hef— as she slowly slipped under. 

But the ultimate defeat— a suicide attempt that came too 
close to succeeding — turned into a triumph. Somehow 
"the knot of despair" broke apart in Janets mind. And 
revelations followed. 

Janet and Paul now -question those ten terrible years. 
After thousands of psychiatric sessions, how could Janet 
wake up knowing so little about herself? Too Much Anger, 
Too Many Tears sounds the battle cry against the tyranny 
of the psychiatrist who is answerable to no one. It is a cry 
of pain and love' that must be heard. 

"A powerful explosive story, often m vivid as a good novel . . . 
Everybody even remotely interested in mental health will want 
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a painfully and minutely documented journal of a personal 



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Senator Bayh. Can you tell us some of your experiences in trying to 
get them ? AVhat State are we talking- about \ 
Ms. Gotkin. New York State. 

Senator Bayh. Does the New York State law say that a patient can- 
not be granted access to their own records ? 

Ms. Gotkin. Well, it is an interesting question. The New York 
Mental Hygiene Law outlines specifically who may have access to a 
person's psychiatric records, and among the people who specifically 
may have access are social service agencies, law enforcement agencies, 
legal personnel in particular situations, people who are designated 
acceptable by the patient, but not the patient themselves. It does not 
say the patient may not have access. It is implicit, rather than explicit. 
But in practice, an ex-mental patient cannot have access to their 
records, unless they go through the procedure of requesting a doctor, 
and the doctor is supposed to screen out what would be harmful, be- 
cause the assumption behind it, whether it is real or pretended is that 
we have been mentally ill, or we will be mentally ill, and therefore, 
are not stable enough to see what has been written about us. 

My own interpretation is a much more political one. I do not know 
if you are interested in it right now. I think the hospitals are very 
intent and very serious upon maintaining a certain power, a certain 
secrecy, and that they are able to function the way they have func- 
tioned, psychiatrists are able to administer drugs in the way that they 
have been, they are able to call the things tliat they do treatments 
precisely because the institutions are closed and they are not open to 
scrutiny. 

At, present that is the way the case stands. We lost, and we hope in 
the future, we will be able to bring another case, and somebody will 
win it. 

Over the years that I was a psychiatric patient, I took probably 
every drug, or almost every drug that was available on the market at 
the time. I took Thorazine, Mellaril, Prolixin, Valium, Librium, Tarac- 
tan, all of the barbiturates — Dexamyl, Kemadrin, Doriden, Chloral 
Hydrate — just about everything — Elavil, Tofranil, Amytal, all of 
them, in combination, and in extremely high dosages. 

I took Thorazine at dosages of 800 to 2,000 milligrams a day for 
periods of up to 2 years. I suffered the way people do suffer taking 
these drugs, extraordinarily. The physical* so-called side effects are 
extraordinarily painful. They included for me not being able to read, 
not being able to focus, not really being able to speak because of my 
mouth beinjr so dry. 

Senator Bayh. Were you told why ? 

Ms. Gotkix. I was never informed. The only symptoms — side ef- 
fects — that I was informed about are what are called extrapyramidal 
effects, which are specifically physical effects, such as hands shaking 
and legs shaking. But perhaps tlie most insidious of the side effects- 
so-called — would be that they imitate in a sense what psychiatric 
symptoms might be. I think it would take the strongest among us to 
withstand the sense that we are going crazy. We cannot communicate — 
you know, hear what people are saving. You cannot read. You fall 
asleep in the middle of a conversation, without knowing that these 
were caused by the drugs that were supposed to be helping me. 

This is an experience that has been — I think it will be today, told 
over and over again. And the onlv conclusion I can come to is that the 



8 

motivation behind psychiatrists' not telling us is that they do not want 
us to know, and that they feel — I should not use they with a capital T, 
in a generalization like that, but I am going to anyhow — is that the 
conclusion we come to is that we are even "crazier" or "sicker" than 
we thought we were in the beginning, and part of the — how would I 
call it — plan, for psychiatric patients is that they realize how "sick" 
they are, and on these drugs, it is very hard not to believe that some- 
thing dire is happening to your body and to your mind. 

EFFECTS OF THORAZINE OVERDOSAGE 

I went into convulsions from the dosage of Thorazine I was on. I 
was on 2,000 milligrams a day, and I weighed 88 pounds at the time. 

Senator Bayh. Am I accurate in my understanding that the normal 
maximum dosage prescribed by a doctor, for Thorazine, is usually 800 
units, and you were administered 2,000 ? 

Ms. Gotkin. 2,000 over quite a long period of time. The effects from 
that were quite horrendous. At one time, I felt terrible itching in my 
entire body, and I was given Benadryl, which is an antihistamine, to 
counteract that. I lost control of my facial muscles and my mouth, I 
had difficulty speaking, and finally, I went into convulsions. And my 
doctor at the time — his reaction to it, as he told my husband was, well, 
I am not surprised, because that often happens with that dosage, and 
he reduced it to 1,800 milligrams. 

One of the interesting things is that I went along with all this. I 
was what is called a voluntary patient. And one of the things I wanted 
to stress today was that in psychiatry today, as it is practiced in this 
country, there is no such thing as a voluntary patient. People are 
not as free to leave a mental institution as they were to come in, 
and therefore, they cannot be considered voluntary. And the subtle 
coercions that are used on people to make them take druTS initially, and 
the force that is used to make them continue taking drugs make the 
words "free" and "voluntary" almost bizarre. 

As I was preparing to come today, I was thinking what I wanted to 
communicate, what was most important from me, from my own ex- 
periences to get across to you, and what I came up with was that the 
use of these drugs — these are very dangerous drugs. These are in- 
capacitating chemicals. They cause those to whom they are adminis- 
tered to lose their ability to function, to act, to fight back, in a sense, and 
I think it is not accidental that that is their side effect, or that is a 
maior effect. And I think that the use of drugs in institutions is a 
political issue. I do not mean political in the sense, maybe, that we are 
used to talking about it. I mean political in the sense that it is not 
a medical question, although there are medical aspects. It is not a sci- 
entific question. It is a question of power over people's lives, very, 
very simply. 

And when we are talking about who should administer the drugs 
to whom, under what circumstances, and in what dosages, we are 
really talking about who shall have what amount of power over people 
who do not have any power. I do not want to get into rhetoric. It is 
political, that kind of thing. But I am very convinced that we have 
to look at the issue in that context, and that it is part of a larger issue. 
I do not mean to take exception to what you said. Senator, but it 
has been my experience, and I have come to the conclusion, and it is 



unshakable, on my part, that the institutions we are talking about are 
not designed to help people. If they were designed to help people, in 
some way they would help people. They are, by their nature, places 
where people who are unwanted, for whatever reason, whether they are 
children who are acting up or whether they are people who have com- 
mitted crimes, whether they are just weirdos or people who do not 
want to work, or whatever, they are places where people can be 
dumped. And the way they are set up and the way they function 
make it impossible for anyone who has been inside to agree that they 
are designed to help people. 

Senator Bayh. Let me just say, I do not think there is any Member 
of Congress who has pursued the need to institutionalize large num- 
bers of people who are now institutionalized, because the response 
of the institution to an act of a citizen is almost to insure that the 
next act of the citizen is going to be worse than the first act. And 
almost the very structures and the number involved defy treating 
the personal problems. 

And I would hate to go as far, myself, as you have gone. 

Ms. Gotkin. That is why I am here, and you are there. 

Senator Bayh. Not necessarily. You have been there, and I have 
not. That is why we want you to be completely open and candid and 
aboveboard. 

Let me make certain. We are talking about an institution to treat 
those that are mentally ill ? 

Ms. Gotkin. We are talking about an institution that calls itself a 
mental hospital. 

Senator Bayh. What was the name of the institution ? 

Ms. Gotkin. There were three involved. .One of them was Hillside 
Hospital, a private, quite prestigious institution in Queens, in New 
York City, where I was a patient for 10 months. Another was Gracey 
Square Hospital, which is known among the knowledgeable in New 
York City as the gilded cage, and the other was Brooklyn State Hos- 
pital, which is a State institution, where I was for 13 months. 

Senator Bayh. You really were in two private institutions and one 
public institution; and they all were what we, as laymen, would call 
mental institutions ? 

Ms. Gotkin. Yes. 

Senator Bayh. I understand you voluntarily committed yourself 
to those institutions ? 

Ms. Gotkin. I suopose that would be accurate. What I was trying to 
get at before was that, although I voluntarily — in other words, no- 
body — the men in the white coats did not come 

Senator Bayh. I understand, but legally, you did not have the help, 
with women on each side dragging you into the ward ? 

LEGALLY, A VOLUNTARY PATIENT 

Ms. Gotkin. Exactly. Legally, I was a voluntary patient. 

Senator Bayh. You and your husband both agreed to this "treat- 
ment'' on your own ? 

Ms. Gotkin. Yes. 

Senator Bayh. Did you have symptoms of violence, in which you 
were dangerous to those who might have been called upon to treat 



10 

you? Did you threaten to tear up the place, or do bodily harm to 
anyone ? 

Ms. Gotkin. No; never. My major symptom — and I think if we 
get into this, we are getting into some really heavy stuff — I was what 
was called suicidal. I think in this countrv there is no — within the 
mental health establishment and related fields — there is no worse sin 
you can commit than to be suicidal, for whatever reason. And lord 
knows, we have done enough talking about it and trying to figure 
out whv. But I think if you in any way raise vour hand against 
yourself, the establishment comes down very heavilv, and I would say 
that was — in each of the instances I was hospitalized, that was the pre- 
cipitating factor. 

Senator Bayh. One of the excuses, or one of the reasons for this 
heavv sedation is to protect a patient from doing danger to herself. 
or himself, or to those around them. Now. you had no problems with 
thrashing out, violence at others. But they were concerned about 
suicidal tendencies. Had you made an effort to try to commit suicide? 

Ms. Gotkin. Yes; I had several times, and I continued to several 
times, over the years. I would sav. of all of the effects, the inhibiting 
effects that the drugs had, that was one thing they never affected, 
and I do not see how thev can. I think the onlv way to affect that is to 
tie somebody up, tape their mouth shut, and tie their hands behind 
their back. 

Senator Bayh. Had yon tried to commit suicide by taking an over- 
dose of drugs, or anvthing like that ? 

Ms. Gotkin. Initially, I cut my wrists, and I did that several times, 
during the 10-year period. I took several overdoses. I was a classic 
case. In case you are interested. I was diagnosed as a chronic schizo- 
phrenic. I do not know if you are aware of the use of the term 
schizonhrenia. It is a catchall definition. 

Senator Bayh. It is a verv convenient title. 

Ms. Gotkin. It is a very convenient title. It is a highlv sitgmatizing 
title. It is a label. It is not a demonstrable fact, It never has been. But 
its effect on the person labeled, mvself. and on the people doing the 
labeling", is to somehow assume from that moment onward that the 
person they are dealing with is somehow not quite a member of the 
human race. It is not iust schizophrenia. I think anv attribution of 
mental illness has the effect on the people using the term to cause them 
to say, well, she does not reallv know what she is doing; I mean, 
she is crazy. After all. Dr. Blahblah savs she is a chronic schizophrenic, 
or she is a manic depressive, denressive, or, you know she is green 
grass ceilings — it does not matter what word von would use. The 
fact that established mental health industrv accepts that as a term 
of derogation — I do not think there is any question about that — makes 
it, in itself, debilitating. 

BELIEF OF DRUG DEPENDENCE 

Over the years, I came to believe that I was what I was called, and 
perhans that was the worst aspect of it. I came also to believe that 
I could not survive without the drugs. 

Senator Bayh. Was that Thorazine, phenothiazine ? 



11 

Ms. Gotkin. Phenothiazines, mostly; and as I say, I took other 
varieties. I took Prolixin, and I am not sure if that is a phenothiazine. 
Senator Bath. Yes; that is a phenothiazine. 

Ms. Gotkin. And the minor tranquilizers — I was very often, more 
often than not, on three or four drugs at a time. 

Senator Bayh. May I ask you, were you addicted to phenothiazine 
before you went into the institution ? 

Ms. Gotkin. I was never administered — the first time I was ad- 
ministered phenothiazines and other drugs was in 1962, after my first — 
for some miraculous reason, I escaped being drugged in the time I 
was in Hillside Hospital. When I was released, into what was called the 
custody of a psychiatrist, who treated me for 8 years, the first session 
that I saw him, he gave me drugs. He never examined me. He never in 
any way tried to determine whether I had something that could or 
should be treated. He gave me, that first session, a little white box 
of Stela zine. And he said, if you feel anxious, take one. A month 
later, I was on almost 1,000 milligrams of Thorazine, and from then 
on steadily, except for periods of having electroshock treatment, 
I was on very heavy dosages of phenothiazines. 

I was terrified, I begged, I cajoled, I went down on my hands and 
knees for higher dosages of the drugs. I do not know what you would 
call it. I never experienced the withdrawal symptoms that I have 
heard from many, many people are excruciating. But I would certainly 
say I was addicted to phenothiazines. I could not prove it, and you 
will get an array of psychiatrists who tell you that they are nonaddic- 
tive and not habit forming. But my personal experience and those of 
others seems to refute that. 

Senator Bayh. What did you do while you were between stays at 
institutions ? Did you have a craving ? 

Ms. Gotkin. I was on drugs all the time, in and out of institutions. 
For 8 years, I was never not on at least one of the drugs we are 
talking about. 

Senator Bayh. I must say that I am not equipped to know how 
to properly treat someone who has suicidal tendencies. Yet for a 
person with an affliction or yearning, and for those who love them, 
it is only normal to try to seek treatment. But it is rather strange to 
me, as a layman, that when a person is custodialized, observed, where 
all an individual has access to is carefully monitored and regulated, 
that one needs to be concerned about someone committing suicide. In 
an institutionalized setting, and by the normal custodial care of 
observation, you ought to be able to keep someone from doing away 
with themselves without giving them 2,000 units of Thorazine. 

Ms. Gotkin. I was on the outside at the time I was taking the very 
high dosage. I was not in the institutions. I was taking drugs when 
I was in the institutions, but I think my drug dosages were even higher 
when I was outside. 

Senator Bayh. How high were they when you were outside? 

MULTIPLE DRUG OVERDOSAGES PRESCRIBED 

Ms. Gotkin. 2,000 was the highest I ever took. At one time I was 
on 1,000 milligrams of Mellaril a day, and Librium, and Doriden, 



12 

and a drug called Kemadrin, which is to counteract the extrapyram- 
idal symptoms. I do not know if you are aware that drugs make you 
constipated. I was taking laxatives and birth control pills, Darvon 
for pain, Compazine for nausea, and all of this was prescribed by a 
doctor. And the doctor I was in treatment — that is in quotation 
marks — with, over this 8-year period, was in a constant state of 
changing my medications. He was convinced that there was something 
elusive wrong with me. If he could only get the right combination, 
you know, it was a modern version of your mad scientist. 

This was before Prolixin became a popular drug, but his experiment 
at one time was to build me up on Prolixin to levels that had never 
been achieved in human beings before. 

Senator Bayh. Did you ever express concern? Did you ever tell him 
you felt like a walking pill box, and you rattled when you walked ? Did 
you ever ask him not to do this ? Did you ask him to be careful ? 

Ms. Gotkin. No; I did not. And that is perhaps one of the points 
I would like to have come clear. I believed I was mentally ill. I 
believed I needed the drugs. The fact that they made me miserable 
and they did not help me was because we had not found the right 
drugs. They may say I was naive, but I think this is a very common 
thing, because part of psychiatric treatment is to cause the person 
being treated to go along with whatever the treaters want to do. 

Senator Bayh. Well, most of us need a doctor, or you would not be 
there in the first place. That is sort of traditional doctor-patient rela- 
tionship. But did your doctor ever make the observation about the 
need for caution ? 

Ms. Gotkin. He took periodic blood tests, which are indicated on 
high dosages of phenothizines, and that was all. In fact, he did drug 
research at an institution in New York City, and one of his favorite 
things of saying was that the literature that the drug companies dis- 
tributed outlining the highest safe dosages were overcautious, and 
we did not need to pay any attention to them. 

Senator Bayh. This was your doctor? 

Ms. Gotkin. Yes — the literature that the drug companies included 
in their drugs saying, for example, 600 or 800 mg of Mellaril a day 
is the highest safe dosage — he said, well, they are overcautious and 
we do not need to listen to them. And we did not listen to them. I 
mean, I listened to what he said, and he did what he felt like doing, 
basically. 

Senator Bayh. He actually said that the precautions written in 
the instructions did not need to be observed ? 

Ms. Gotkin. He said they were overcautious — the drug companies. 

If I could just say one more thing, because I feel very strongly 
about it, since I am here, you are listening to me. I gave a lot of 
thought to the problem, and the ways in which it could be cooed with. 
And someone asked me, in the process of preparing my statement, 
what kind of controls I thought should be instituted, how I thought 
this problem could be dealt with. And what I came up with, very 
strongly, was we could institute all kinds of controls, things that have 
been tried, and variants on them, professional review committees, and 
all sorts of committees. And I think that we would be skirting the 
issue, basically. I am speaking not for the mental patients movement, 
although I think I express some of their feelings, that what we really 



13 

feel is necessary is to stop drugging of incarcerated people, and that 
we really are not facing the issue when we say, well, let us take the 
power to decide away from the psychiatrist, and let us give it to the 
lawyers, or the judges, or the legislators, or the human rights com- 
mittees. Because nobody is saying let us give the power to decide back 
to the people who are affected, just as no one is saying, let the mental 
patients have their records. 

NEED FOR VOLUNTARY SYSTEM OF MENTAL HEALTH CARE 

I do not think that this kind of return of power to the people who 
are concerned can take place unless there is a voluntary system of 
mental health care; in other words, unless the laws to allow people 
to be locked up and treated against their will are eliminated. I am 
making a plea for that. I think the system, the mental health system, 
is basically corrupt and irretrievably rotten. And although we might 
put a Band-Aid here and a splint there, I do not think we would 
really end up protecting the people who are incarcerated, unless the 
system is changed. 

Senator Bayh. Thank you very much, Ms. Gotkin. 

I wish you would read that first full paragraph for us — on page 5 
of your prepared statement. Particularly that last sentence, it is so 
descriptive. 

Ms. Gotkin. That paragraph starting "In all the years" ? 

Senator Bayh. Yes. 

Ms. Gotkin. In all the years I took these drugs, never once did 
they in any way help me to solve my problems or come in touch with 
my feelings. Quite the contrary. I never had to face any problems 
because they were all called "symptoms" and I was given drugs to 
deal with them. I became alienated from myself, my thoughts, my 
life, a stranger in the normal world, a prisoner of drugs and psy- 
chiatric mystification, unable to survive anywhere but in a mental 
hospital. The anxieties and fears I had lay encased in a Thorazine 
cocoon and my body, heavy as a bear's, lumbered and lurched as I 
tried to maneuver the curves of the outside world. 

Senator Bayh. Thank you. 

Are you taking any of this kind of drug now ? 

Ms. Gotkin. No. I have not touched the stuff in 5 years. 

Senator Bayh. I am glad to hear that. Thank you. 



PREPARED STATEMENT OF JANET GOTKIN 

Mr. Chairman, members of the committee, my name is Janet Gotkin and I am 
an ex-mental patient. For 10 years I was on the receiving end of what is called 
psychiatric "treatment" and my only claim to expertise is my experience as a 
psychiatric guinea pig. 

I was always a so-called "voluntary" patient, but I hope you will not allow 
semantic niceties to obscure my true status. Whenever force, threat, or coercion 
exist, and whenever a person does not have the option to leave an institution or a 
"therapy" situation, the word "voluntary" does not apply. There are few, if 
any, truly voluntary mental patients in this country. I wish to stress this 
initially, and stress, too, that my experiences are in no way unique. I am one 
of thousands. What makes my story of particular note is that I survived, intact, 
and am here to speak to you today, instead of moldering, lethargic and drugged, 
a resident of the back wards. 

In September of 1970, after a near fatal suicide attempt that culminated in 
a 5-day coma, I ended my 10-year career as a mental patient. Diagnosed as a 

8-3-303 0—77 3 



14 

"chronic schizophrenic," I had spent a total of three and a half years in mental 
hospitals, both private and public. I had attended nearly 1,000 psychiatric 
sessions, I had received over 100 electroshock treatments, and, my husband and 
I estimate, I had received over 1 million milligrams of tranquilizers. By all 
professional estimates, I should have remained a mental patient for the rest of 
my life. But I didn't. 

What happened in my head during my coma to allow me to leave my psychia- 
trist, overcome my 10 years of debilitating treatments and debasing definitions 
and assume control of my own life? The 5 days are a mystery. But I remember 
my waking up as clearly as if it was this morning. More than anything, it was 
an experience in vividness. I woke, 

. . . not with the sickening sour sense of a failed suicide attempt, but 
with a tingling joy-shouting feeling. "Thank God I am alive !" 

And I was alive, truly, for the first time, perhaps, in my life. My mind 
was clear; my symptoms gone. I read The New York Times; I read an entire 
book, Yasunari Kawabata's The Sound of the Mountain; I saw a whole 
movie. People's voices came through clear and precise. My hands and legs 
did not shake and I moved my bowels without a laxative. For the first 
time in 8 years I was without drugs and it felt fantastic. 1 

I realized, in a rush, how much of my misery and pain and how much of what 
I had been encouraged by my psychiatrists to call my "illness" had been drug- 
induced. This realization radicalized me and gave me the initial strength to 
declare my independence from psychiatry. My senses, my mind, my body were 
free and freedom is a dear and heady thing. I vowed never to give it up again. 

In all the years I was in so-called therapy and mental hospitals my primary 
"symptoms" [otherwise known as sins/crimes] were a deep, abiding sense of 
hopelessness, an erratic fright upon confronting the symbols of normality of 
our society [school, authority, bureacracy, office work, subways, etc.] and con- 
tinuing desires and attempts to cut my wrists and otherwise end my life. For 
these I was punished through drugging and incarceration and electroshock. I 
was labeled "schizophrenic" and considered an acceptable recipient of the 
punishment/tortures that pass for psychiatric "treatment." 

I was put into a mental hospital for the first time in 1961 after I cut my wrists 
in my psychiatrist's office and in the 10 months I was there miraculously avoided 
being drugged. When I was released, finally, into the custody, so called, of the 
psychiatrist who was to treat me for the following 8 years, I started the night- 
mare of being a psychiatric druggie. 

During my first session with Dr. Sternfeld ' he gave me drugs. Stelazine. I 
think it was. He never examined me, took tests, or in any other way tried to 
determine if there was a condition I had which might warrant drug treatment. 
"If you feel anxious, take one," he said. Within a month I was on Thorazine, 
the granddaddy of tranquilizers, and from then on, I was hooked. Over the years 
I took almost every drug on the market : Thorazine, Mellaril, Taractan, Compa- 
zine, Stelazine, Serax, Prolixin (Permatil), Valium, Librium, Miltown, Doriden, 
Nembutal. Seconal, Tuinal, Chloral Hydrate, Sodium Amytal [by injection], 
Dexamyl, Kemadrin, Tofranil, Elavil. You name it, I took it ; often in combina- 
tions ; mostly at very high dosages. At one time, for example, I was taking Mel- 
laril [800 mg. daily], Compazine [for persistent nausea, caused, most likely, by 
the drugs themselves], Librium [20 mg. daily], and Doriden [two pills per 
night], as well as Kemadrin [to reduce the extrapyramidal symptoms], Darvon 
[for headaches], a daily laxative, and birth control pills. I freaked out on Elavil 
and Tofranil, overdosed on Doriden and Mellaril, and suffered the excruciating 
pain of being in bondage to Thorazine and to its dispenser. At one time, I par- 
ticipated in an "experiment" with Prolixin, to. [in the words of Dr. Sternfeld] 
"build you up to unheard of levels," but I stopped because my fear was so great 
it counteracted the "good effects" of the drug. 

For months at a time I took dosages of Thorazine ranging from S00 mg. a day 
to 2,000 mg. a day. At 2,000 mg. I felt myself going mad with the sensation of 
bugs crawling over my body ; Dr. Sternfeld gave me Benadryl to counter the 
itching. I began to lose control of my lips and tongue : it was difficult to speak. 
Finally, one night. I went into convulsions. Dr. Sternfeld told my husband, "I'm 
not surprised. It often happens at this dosage." And he lowered me to 1.800 mg. 



1 Gotkin. Paul and Janet. Too Much Anner. Too Many Tears: A Personal Triumph Over 
Psychiatry. New York. Quadranjrle Books. 1975. 

2 This is not the real name of the psychiatrist. 



15 

Dr. Sternfeld was always changing my "medication," always trying out new 
combinations, new dosages. He was scornful of the precautions the drug compa- 
nies issued in their literature. "They say 800 mg. of Mellaril is the highest," he 
said. "But they're overcautious. We can go higher." And ive did. In search of the 
elusive right combination, Dr. Sternfeld never wavered. And, as the years went 
by I forgot, until that day in September when I awoke from my coma, what it 
was like to be totally alive and perceiving the world, drug free. 

In aU the years JLtm k. these drugs never, once, did thev in a nv way help me to 
s olve my p roblems or come in touch with my feelings. _Q uite the contrar y. I neve r 
had to face" a ny problems her-a~n~sp ~""thpy were all palTerl "svTiip tnnia" a pd I was 
given drugs to deal with them . I became alienated from my self, mv t hou ghts, in v 
life, a _stranger in the normal world, a prisoner of drugs and psychiatric mysti - 
fication, .unable, to sur vive anywhere, hu t, in a mental hosp ital. The anxieties and 
fears I had lav encased in a Thorazine cocoon and my body, heavy as a bear' s, 
l umbered an d l urched as I tried ~to~mane uver the~ _c.ux.ves of the "outside wofTd . 
My tongue was so fuzzy, so thick, I could barely speak. Always I needed water 
and even with it my loose tongue often could not shape the words. It was so 
hard to think, the effort was so great ; more often than not I would fall into a 
stupor of not caring or I would go to sleep. In 8 years I did not read an entire 
book, a newspaper, or see a whole movie. I could not focus my blurred eyes to 
read and I always fell asleep at a film. People's voices came through filtered, 
strange. They could not penetrate my Thorazine fog ; and I could not escape my 
drug prison. The drugs made me constipated, as well as ravenously hungry. As 
a final misery, they caused me to gain weight. For 8 years I took laxatives and 
suffered as I watched my body grow heavy and distorted. My hands shook so I 
could barely hold a pencil and I was afflicted with what Dr. Sternfeld lightly 
called "dancing legs," a Parkinsonian "side effect" of these chemicals. For this 
I took a drug called Kemadrin, and if I missed a day or a dosage, my shoulder 
muscles would tighten into excruciatingly painful knots and my legs would go 
wildly out of control. Exposure to the sun caused painful itching and even, on 
occasion, serious burning. 

Yet to detail the physical suffering caused by these drugs is to touch on only 
one aspect of the pain they cause. Psyc hologically and emotional ly t hey are 
devastating. They cause sensations [drowsiness, disorientation, shakiriess, dry 
mouth, blurred vision, inability to concentrate, to mention a few] that would be 
enough to unnerve the strongest among us if we did not know their source. It is 
a^ommon_p ractice among psychiatris ts^ not to info rm t heir patiej Ugthatthe 
disturbi ng things They are expeTTe hcihg~ar e drug in gucedTMy only~clmcTUgibn is 
thatThey prefer the patients to assume that the bizarre things their bodies are 
doing and the strange turns their minds are taking are further indication s oj 
how "sick" or "crazy" they arp And this is precisely what happens. 1, like "most 
victims of psychiatric drugging, did not link up my difficulty in concentrating and 
speaking, my heaviness and my problems in communicating with the drugs that 
were supposed to be "helping" me. My hands Would shake as I held a coffee cup, 
my legs would beat a wild tattoo on the floor, and sometimes I would fall asleep 
in the middte^oTITeonversation. I kneiv I was deteriorating, going slowly, surely 
insane. No one thought it necessary to advise" me otherwise. "But why do you 
think people are looking at you strangely?" Dr. Sternfeld would ask. Why indeed ! 
In spite of evidence to the contrary and in spite of the pain that the drugs 
caused me. I believed, wholeheartedly, that I could not survive without them. 
Many times I cried, pleaded, cajoled, even begged on my hands and knees for 
higher and higher doses. Would you call this dependency? Or addiction? Does 
it really matter what you call it? One thing is certain. I needed those drugs. I 
would have done almost anything to get them and I would have allowed the 
person giving them to me to do almost anything to me in order to keep my supply 
coming. 3 — And I did.* 

I received a letter last week, and in it, a young woman who has gone through 
similar experiences to my own says, "First they get you so you can't live without 



3 In 8 years. I never personally experienced the horror of withdrawal from these so-called 
nonnarcotic, nonhabitforming drugs. I have heard enough stories, from people who have, 
tn make me enduringly grateful that my withdrawal occurred during a 5-dav period of 
unconsciousness. 

4 For me. and thousands like me. dependence on these drugs has meant total submission 
to the wishes of a psychiatrist. It has meant submitting to hospitalization, shock treat- 
ments and all manner of demeaning and humiliating treatments — all in order not to 
alienate the source of drugs. 



* 



16 

the drugs, then they say they'll stop treating you if you don't do what they want." 
There, simply stated, lies the incredible power of these drugs and an insight into 
how they determine the power distribution between psychiatrist and patient. 
When you are drugged you are passive, vulnerable, suggestible, and easily man- 
aged. Your symptoms, i.e. your anger and hostility toward your tortures, dis- 
appear and you become a "good mental patient." 

Do you know why doctors will fight to the last to retain their uncontrolled 
rights to administer these chemicals promiscuously and indiscriminately to their 
charges? Because these are incapacitating chemicals. They cause us to lie down 
like dogs and slobber for more. Or, at the very least, t hey ta ke away our anger , 
rmr spirit, and our TOi11 ; ^ey i-pIipvp us n f our ability to fight. With the ir_dxugjs^ 
thei r weapons— psych iatrists c an do w it h us as they jike;_ancL we wiUb axely 
whimper. 

""\vnat 1 am saying may be new to you, but it is an old and sad story to anyone 
who has been a psychiatric prisoner in this country. You could hear horror stories 
like my own and worse, hundreds, thousands of them, if you just cared to go to 
our so-called mental hospitals and asked a few questions of the patients. And 
you could have heard these same frightening truths for many years. These 
abuses are nothing new. Yet very few people have heard about them. 

Two months ago my husband Paul and I did a radio interview for the Canadian 
Broadcasting Company on the subject of depression. When my husband men- 
tioned, in response to a question, that many people have suffered terribly adverse 
reactions to drugs such as Tofranil, the woman interviewing us was shocked. 
She had never heard such a thing. Were we sure? It seemed incredible to us, and 
incredible it is, that such ignorance and naivete could exist. But it does, most 
certainly. It is important and pressing to ask whv the truths about, psychiatr ic 
practh?esingener al, and drugs in part icul ar, have rem ajneds o welF hiddenT 
^Part ot thlTanswer is that mental hospitals [as well as"prisons ana schools for 
the retarded] are closed institutions. The people who run them have been vir- 
tually free pf_a ny outside scrutiny or constraint on their behavior and have fought 
hard to maintain that closed status. Little concerted effort by the public has been 
raised, except for periodic "exposes" of panel and psychiatric institutions that 
result in nothing more than widespread outrage. It is precisely because these 
institutions are "secret," in the sense that they house society's unwanted, that 
no one really wants to investigate what goes on inside. It is easier to abrogate 
responsibility for the unpleasant, the eccentric, the antisocial, the aberrant among 
us — and leave their care (?) to the experts. 

Historically, psychiatrists and penologists have been most eager to assume that 
responsibility and to cloak their activities in an aura of mystery and exoticism. 
Until recently there has been a politically activist mental patients movement, 
since traditionally mental patients have been so brainwashed [through psy- 
chiatric jargon as well as through drugs] into believing in their own incompe- 
tence and "illness," they never dared to move to expose the tyrannies of psychia- 
tric practice. With the emergence of the mental patient movement in this country 
in the last 3 years, as well as with the growth of consumerism, the doors to the 
mental hospitals and prisons are being forced open, bit by bit. And what we see 
is shocking and horrifying. 

We are so surprised, too, because, whether we know it or not, we have, most of 
us, been victims of the extraordinarily effective public relations campaign of 
the American Psychiatric Association. We have, over the years, accepted their 
definition of themselves as a "professional" organization, and lost sight of the 
fact that their major function, like the American Medical Association and the 
American Bar Association, is to form favorable public opinion. We accept their 
studies as unbiased, their statistics as valid, their views and preferences in 
"treatment" as scientifically sound. We are only just beginning to see that we 
have been duped and that the other side of the rosy picture of mental health 
practice we are fed through the media is so appalling as to be almost 
indescribable. 

We are learning that the mental hospitals are more like prisons than hospitals, 
that so-called doctors are administering potent and dangerous, mind-altering 
substances indiscriminately and without examinations to persons incarcerated 
against their wills. We are learning that children are among the prime targets 
of this drug abuse, and that there are no standards for psychiatric evaluations 
and diagnoses. We are learning that threats, coercion and dangerous practices 
are the norm, not the exception. 

The use of these dangerous drugs is essential to modern psychiatric practice. 

They are the major vehicle for psychiatric oppression in this country and their 

use is expanding rapidly to include many varieties of captive clientele, from 



17 

mental patients and prisoners to juvenile offenders and geriatric patients to 
schoolchildren. They cause untold misery and pain and permanent brain damage 
in many of their victims. They are used to threaten, punish, and manipulate 
already helpless people and they are administered by people who, by and large, 
know little or nothing about how they work or their long-term effects and who 
seem to have little interest in finding out. They are used, not to heal or hel p, out 

to to rture and control. It is that simple. — 

"And" the questions~5urrounding their use are not scientific or medical ; they are 
political. When we talk about who shall administer what drugs to whom and 
under what circumstances, we are talking about power over people's lives. These 
are dangerous drugs, dangerous from a physical point of view a nd from a moral 
point of vie w. They are dangerous because they imbue the dispenser with tre- 
mendous power and reduce the receiver to a state of helplessness. They are 
especially insidious because they leave no marks and because their victims — 
mental patients, old people, poor people, "criminals" — are among the most power- 
less and stigmatized groups in our society. 

When we see the rampant abuses connected with institutional drug abuses 
we are seeing only one aspect of a profound problem. We must confront the 
basics. The mental hospital system in this country is unendurably rotten, es- 
sentially and irretrievably corrupt. The misuse by psychiatrists of psychotropic 
drugs is just one aspect of that corruption. We could, theoretically, face that 
aspect of the problem — drugs — and institute "controls" of some sort, standards 
for administration, etc. We could plan professional review committees and 
patient review committees and committees to oversee committees. We could call 
in lawyers and ombudsmen and community workers and insist on rigorous in- 
formed consent procedures — if we believed informed consent could exist in the 
essentially coercive environment of a mental hospital or prison, which we 
don't. But we would be skirting the issue. We would not be accomplishing what 
we really want, which is to stop the forced drugging of incarcerated persons. 
We don't want to take the power away from psychiatrists, just to give it to 
legislators or judges or human rights committees. We want to take it and give it 
to the people whose lives and bodies and minds are affected. 

Qf course, we can and should support the mo vement to allow psychiatric in-_ 
mates the right to refuse drug s. That is an important liberatin g_step. But, in 
t he end, it is only a stopgap measure . We cannot truly ensure that coercion and 
force are not used ana that mental patients interests will be protected until 
we have a truly voluntary system of mental health care. Only when the law 
does not allow people to be locked up against their wills to be "treated" and only 
when people are as free to leave an institution as they were to enter will the 
balance of power between the dispensers of "treatment" and the receivers begin 
to be restored. 

And it will not be easy to achieve a noncoercive, humane system for pro- 
viding care and real help to people in trouble. Psychiatrists and mental health 
professionals have fought us in our efforts to achieve such a system and they will 
continue to fight us every step of the way. Because, again, this is a political 
issue, a question of power. Laws allowing for involuntary mental hospitalization 
imbue psychiatrists and judges with tremendous power, as do the awesomely 
powerful drugs we are discussing. People who are free to come and go. ask ques- 
tions and demand answers, whose brains are not fogged, who are not demoral- 
ized and incapacitated will be free to be as militant and self-serving as they 
choose. They will not settle for vague answers and t hey will demand to kno w 
\vha_t_js_^elng__g iven to them, how it work s, its rlflmz oc&__anri pjvantj )gr Pg Ti^y 
WiTTnot allo w themselves to be made into psychiatr i c zombies or to be categorized 
as Iacking"Tn the _judgme nt necessary to decide what is in their own best in- 
terest. They will wrest the power from" the psychiatrists, institute responsive 
helping alternatives and take control of their own lives. The psychiatrists know 
this and they are afraid. 



Senator Bayh. Mr. Brandt, we appreciate your being with us. 

STATEMENT OF ANTHONY BRANDT, AUTHOR/JOURNALIST, 

SHRUB OAK, N.Y. 

Mr. Brandt. Thank you. 

I appreciate the chance to be here. My name is Anthony Brandt. 
I am a freelance writer. I have a book coming out next week on the 



18 

mental health system. I spent 2% years doing research for this book, 
visiting various States across the United States, visiting mental health 
facilities, talking to officials at all levels in the system, to workers in 
the system, and to a good many ex-mental patients. I also committed 
myself to Hudson River State Hospital in Poughkeepsie, N.Y., to 
find out for myself what it is like to become a mental patient. And while 
my experience is very limited, I think it is typical of what happens 
to mental patients in this country. So why do I not begin with that, 
with what I did ? 

[Exhibit No. 2] 

An explosive expose of the 

treatment of mental patients in the 

U.S. The first-hand account of the 

author's own simulated breakdown 

gives a close-up view of what 
happens to the "mentally ill" who are 
shoved into hospitals to be "cured". 

$9.95 

Reality 
Police 

The Experience of 
Insanity in America 

BY ANTHONY BRANDT 

I went to Hudson River on a Friday evening, and told them that 
I was hearing voices, told them that I was separated from my wife, 
which I am not, and that I needed help. I had a friend with me who 
confirmed the story and said, you know, he is really kind of in a bad 
way. They listened to my story, and then they called in the resident on 
duty that night, and she was a foreign medical graduate, from India, 
I believe, I had a little trouble understanding her ; she did not speak 
English too well ; and I assumed she had a little trouble understanding 
me. 

Senator Bath. Could she hear the voices ? 

Mr. Brandt. No, no. She talked to me for about 10 minutes, and gave 
me what is standard in the institutional field, a reality test, which 
consists of asking you who the President of the United States is, and 
what day it is, and what time it is, and do you know why you are here, 
what you are doing here, and so on. She listened to my story, and then 
she admitted me. The whole process took about 10 minutes, which is 
standard also. 

Then an aide took me up to the ward, after I had signed the papers, 
and they stripped me, and searched me in the shower room, and they 
took my belongings away and gave me hospital pajamas and a hospi- 
tal nightgown, and canvas slippers, and a bathrobe without a tie 
around it, because mental patients do not have long, thin things that 
they can possibly hang themselves with. 



19 

NO MEDICAL EXAMINATION PREVIOUS TO INJECTIONS 

Then they took me into the nurse's office, and there was a nurse 
there, a male nurse, and he prepared an injection of a drug known as 
Serentil, which is a phenothiazine. They gave me the injection, and 
then they led me off to bed. I knew nothing about the drug at the time, 
and they did not tell me what the drug was. I just happened to find 
out what it was. I looked at the box and saw the name. 

Then they left me in bed. That was it. They did not really say any- 
thing to me, or explain anything to me, and there was no medical ex- 
amination at all. 

A little later, my mouth dried out very badly, and I was desperate 
for a drink of water. I could not sleep. You are on a thin little mattress 
that has a rubber sheet on it, and a rubber-encased pillow, and it is a 
weird feeling, because the sheet is sliding all over the rubber, and you 
do not know whether you are going to wind up on the floor at any 
moment. So I got up, and I wanted to go out in the hall, and get a drink 
of water. On the way there, I discovered that I really could not walk. 
I kept stumbling and grabbing for walls, and trying to support my- 
self, and I fell down twice, once on the way to the water fountain — I 
did actually get the drink of water — and then I fell down again on 
the way back to bed. 

I discovered later than one of the main side effects of Serentil is 
severe hypotension, and since I have low blood pressure anyhow, this 
exacerbated that condition, and that would explain my inability to 
walk. 

Now my feeling about it is that — I think two facts about it are signif- 
icant. There was no real psychiatric diagnosis made. You cannot make 
a psychiatric diagnosis in 10 minutes. The next morning, a psychiatrist 
did come in and talk to me for iy 2 hours, at which time my drugs were 
changed. The other fact that is significant is the hypotension. And 
together, the way I put these together is that the basic purpose of that 
drug was not to quiet my mind but to make me incapable of movement. 
I think it was in effect meant to immobilize me. I cannot prove it, 
but my subsequent experience in that mental hospital, and talking 
to all of the mental patients that I have talked to, indicates to me that 
the basic purpose of these drugs is to control patients, and not to help 
them. 

Senator Bath. Excuse me, but could you think with your mind, 
at the time that you could not walk ? 

Mr. Brandt. Yes, I could think. My head was clear. My head was 
clear when I went in. The drug had no effect whatsoever on my thought 
process. But I could discern, after I got used to the ward — well, you 
never get used to the ward. There is no way to get used to the ward. 
But in the subsequent 11 days that I was there, I did learn something 
about the use of the drugs. Everyone on the ward was getting drugs, 
without exception, at, I believe, very high levels. 

Most of the people on the ward slept for at least 12 hours a day. 
A good many of them sat around the ward all day long, either staring 
at the walls, or staring at television. 



20 



OBJECT AND GET "SNOWED" 



I heard stories from some patients about what happens when you 
get intractable, or when you object to taking drugs. Usually, you get 
the effect — what the psychiatrist calls "snowing" — if you refuse to 
take a drug. Some aides come by, and they grab you and they inject 
three or four times the normal dose of the drug into you. This is very 
common. 

Senator Bayh. Did you have that experience yourself? 
Mr. Brandt. No; I did not. Once I had the Serentil, I figured 
I had better behave, because I did not want that experience. I was a 
little bit afraid. It was a frightening experience not to be able to walk, 
or to maneuver. And I had heard enough stories from ex-mental pa- 
tients to know that these things are dangerous. 

However, I have heard many stories from ex-patients of this hap- 
pening, and I have been able to substantiate some of them, independ- 
ently, from other patients and from people who work on the wards. 
Sometimes this happens without medical approval. The drugs are 
given and they get the doctor to sign the order afterwards. I know 
of cases in Topeka, Kans. where this has happened, and other places, 
as well. 

There is another practice which I think you know about. That is 
to continue the drugs at a very high level, for long periods of time, 
without medical supervision of any substantial kind. I talked to 
an ex-patient who had been at King's„Park State Hospital on Long 
Island for 8 years, and during 5 of those years, he received high dos- 
ages of Thorazine every day. He saw a doctor once a year. 
Senator Bayh. Once a year? 

Mr. Brandt. Once a year; yes. He was lucky; he had 5 minutes 
with the doctor once a year. 

On my ward, patients saw doctors, if at all, on Monday morning 
rounds. Every Monday morning, they came for about 5 minutes and 
stood around. Generally, they did not come in unless there was a new 
patient on the ward. That was your only opportunity to go up to a 
doctor and say, look, I do not feel right on these drugs, or I want 
to get out, or whatever. Otherwise, there was no real therapy at all, 
and no contact with physicians, that I could see. This also is very 
common. 

Senator Bayh. How old were the people in your ward? Were 
they all generally one age group? 

Mr. Brandt. No; they ranged in age from about 18 into their 
seventies and eighties, and some of them were, I would say — and 
this is very impressionistic; you have to understand that. About 60 
percent were, in my opinion, perfectly capable of existing on the out- 
side with no help whatsoever from anybody. That is a conservative 
estimate. 

Senator Bayh. Did you have a chance to talk to some of those to 
find out how they got in there? 

Mr. Brandt. Yes. People were in there for various reasons. One 
young man I remember very well — he was labeled a manic depres- 
sive. He would have made an excellent used car salesman. His parents 
were kind of trigger happy. They got unset verv easilv by his behav- 
ior. He had been in and out of mental hospitals 13 times. He knew 
them very well. He knew the ins and outs. He had girlfriends, you 



21 

know, he knew how to get drugs, if he wanted to, not phenothiazines, 
but drugs like marijuana, and other such things, without any difficulty 
whatsoever. 

He was — as I say, he would have made a good used car salesman. 
He was very alive, very vigorous., You might say manic — a psychi- 
atrist would say manic. I would say he was just a good used car 
salesman. 

There were other people who were there for different reasons. One 
person suddenly got tired of living with his wife, and he did not 
quite know what was happening, and he got very angry with her, and 
one night he threatened her. He got frightened by that, by having 
threatened her, and committed himself to the mental hospital, and 
he was put on drugs. Well, everyone is put on drugs. But he was put 
on the drugs, and after awhile, he did not want to leave. It was com- 
fortable. He could sit and watch television all day, and nobody 
bothered him, and he was well fed — well, he got hospital food. And 
he went home from time to time, but he was really anxious when he 
got home, and he felt dependent on the hospital, and that is a common 
thing. It happens to a lot of people. 

DEPENDENCE UPON INSTITUTIONALISM 

You get institutionalized, and psychiatrists have a term for it, they 
call it institutionalism, whereby a person who spends a long enough 
time in a mental hospital- — it does not have to be that long, it can be 
3 or 4 months — gets used to it, and gets dependent on it, and does 
not car e any more whether he leaves or not. 

An cl this is also an effect of the drugs, too, because, after all , they 
are so-called tranquilizers; they sedaf tTvon And .qfte r awhilp. yon 
just do not care any more. You do not care about anything. And to m e, 
th is indicatespart of their basic nature, really, that th eyar e intended 
mo re for pu rposes of social control than they are to hel p~~people. It is 

well known they cure no one : — ' 

vp i\o one knows how t hey work. Thp.i r use, is empirioah and indiscrimi- 
nate" They do not haU mp ecific drugs for specific illnesses, and they 
usually just try drugs, first this and tSen that, to spp. what WQjj jsjrnft 
w hat does not work, as Janet was describin g. 

""Senator Bahy. Did you continue to get phenothiazine treatment 
while you were there ? 

Mr. Brandt. Yes; the 11 days I was there, I took 150 milligrams of 
Thorazine and 6 milligrams of Stelazine a day. 

Senator Bayh. A day ? Every day ? 

Mr. Brandt. That is right. 

Senator Bayh. Despite the fact that you had no real illness, but 
committed yourself as a ploy? Nobody got around to examining 
you closely enough to determine ? 

Mr. Brandt. Yes; I did have a psychiatric examination of sorts, 
the day after I was admitted, and it was based on that that I was 
receiving the drugs. 

And I was also very lucky in that I was assigned to a therapy 
group, which is quite unusual. I was supposed to get 1 hour of 
group therapy a week, and that is rare. They only do that with young 



22 

people, or people they think that have a chance of getting out. Most 
people do not get any therapy whatsoever. 

Senator Bayh. You obviously talked with some other patients 
there — those that had received what you described as a "snow" 
treatment ? 

Mr. Brandt. Yes. 

Senator Bayh. You say they were given two or three times the 
recommended dosage. How did this come about ? 

Mr. Brandt. Usually it happens when you refuse to take your 
pills, and this can happen for a variety of reasons. If you are on lithium 
carbonate, say, you can get worried about what is happening to your 
blood. They have to monitor your blood very carefully on that drug. 
And so you can say, look, I do not want to take this drug any more. 
I know it is dangerous. 

And this fellow, the one who would have made the good used car 
salesman, was on lithium carbonate, and he knew that that drug is 
very dangerous unless it is carefully monitored. He did not want to 
take it. He told me about a time when he had refused to take that 
drug, and he is a strong young man. So four aides came in, grabbed 

him 

Senator Bayh. Four aides ? 

Mr. Brandt. Four aides, one on each limb, you know, one on this 
arm, that arm, right leg, and left leg, and they injected phenothia- 
zines into him at a level three or four times what is normal. Janet 
talked about drug levels being high at 2,000 milligrams. I have heard 
of people getting 3,000 milligrams of Thorazine at one time. That has 
happened. It does happen. 

Senator Bayh. Could I ask you about this used car sale=man friend? 
You mentioned that he knew the ropes, and he could get other kinds 
of drugs. How did he go about doing that in an institutionalized 
setting ? 

AVAILABILITY — WITH SUFFICIENT MONEY 

Mr. Brandt. Well, I am not exactly sure how. Possibly through some 
of the aides. If you have money, I think it would be p-enerally true that 
you could buy just about anything you wanted. He had an in with 
the aides. He had his own private room. And he had girls in there, 
sometimes, and nobody bothered him. I mean, people seemed to know 
when to stay awav from his room, when he had a girl in it. So I 
assume ho had made a deal with the aides. He would not tell me. 
I did not really press him on this. He just, you know, made it plain 
that this was available to him. 

A mental hospital is a funny place. There is an underground life, 
as well as the official life, and people are constantly trying to make 
out in various ways, and they are human beings, and the regimenta- 
tion is so strong, and so insufferable, that you have to try to make 
a life for vourself somehow. So people do, in very small ways. They 
try to get a source of cigarettes, for example. 

Senator Bayh. What other kinds of drugs? You mentioned mari- 
huana. Did your used car salesman friend have other kinds of drugs? 

Mr. Brandt. That I do not know. It is possible, but I do not know. 

Senator Bayh. You did not hear him talk about that? 

Mr. Brandt. No. 



23 

Senator Bath. Girls and grass. 

Mr. Brandt. Girls and grass, right. That is not a bad life in a 
mental hospital. 

Senator Bayh. Are you sure he did not voluntarily commit himself ? 

Mr. Brandt. No; he was in for 90 days, and wanted very much to 
get out. I have never known anyone who wanted to get out so bad. 

Senator Bayh. His parents put him in ? 

Mr. Brandt. His parents had put him in there. He said the reason 
this time was that they had found him in the garage arranging his 
things, and I guess they got uptight, because he was arranging his 
things, and that was their reason. People are put in for much more 
trivial reasons than that. 

Senator Bayh. How old was he ? 

Mr. Brandt. About 27. 

The main point I want to make is, I would like to put the fact in 
context that use of the drugs really is a technology of social control. 
The entire mental health system is a system of social control, as I 
see it. And I have studied it. It started out 150 years ago in this 
country. These were not mental hospitals. These were asylums or 
institutions of various kinds. They did not have the term hospital. 
And they were not run by doctors. 

medical justification an historical accident 

And the whole medical overlay of this system is a historical accident, 
more than anything else. There is no basic reason for it. People get 
disturbed, and other people on the streets or in their houses, their 
relatives, their friends, their employers, want to do something about 
it. They do not like disturbing behavior around them. And so this 
system has developed as a kind of catchment for these people, for 
the people who are not breaking the law, but they are acting in ways 
that people find disturbing. They cannot tolerate this behavior, and 
the consequence is that they put them in this large system called a 
mental health system, and if you are disturbed enough, you wind up 
in a mental hospital. If you are just neurotic, and you just need some 
Valium, or something like that, you can get by on the outside. But 
if you are crazy enough, they will put you in a mental hospital, and 
they will label you in some way, as schizophrenic, or manic depressive, 
or something, and the medical halo around these terms justifies 
anything. It is just unreal. 

The director of the Center of Schizophrenia at NIMH, a man 
named Dr. Loren Mosher, does not believe there is such a thing as 
schizophrenia. He disavows the term. He disavows the reality of 
the disease. This is not a science. Psychiatry is not scientific. That 
really sums it up. It is an excuse for a science, and the drugs are an 
excuse for psychiatry. 

They make scientists believe they are performing a medical func- 
tion, and they are not performing a medical function. They are 
performing a social function. They are controlling people you cannot 
control in other ways, legally or otherwise. 

I think that this system — it has been with us a long time. I think it 
is going to stay with us. I do not think it is going to disappear over- 
night. I do not think that the quiet revolution that NIMH talks about 
is going to empty the mental hospitals. 



24 

The people I have talked to indicate — and you can find this in the 
psychiatric literature, too — that mental hospitals will always be with 
us, and I think this is true. 

And I think, failing a very broad shift in public attitudes, we have 
to institute some sort of legal controls and legal accountability over 
the abuses which are prevalent in the mental hospitals. And I am not 
an expert on this, but I would like to read the last paragraph, if I 
could, which sums this up. 

SYSTEM FOR LEGAL ACCOUNTABILITY 

We need a system of legal accountability whereby the principle of 
parsimony can be strictly applied to these dangerous drugs. It is not 
enough to rely on mental hospitals to police themselves. Professional 
standards alone have proven inadequate to control the abuses of medi- 
cal power common in psychiatry, where medical and social functions 
overlap. Legal help or a source of appeal ought to be available to 
patients who do not want medication or feel they do not need it. The 
prescribing of neuroleptics ought to be subject to frequent periodic 
review by disinterested physicians. Patients ought to be fully informed 
about possible injurious side effects and the long-term danger of 
tardive dyskinesia. Ethical standards in drug research need to be 
considerably tighter. All of this will make psychiatry's role in the 
mental health system more difficult, but nobody ever said it had to be 
easy. We are talking about people's rights to their own minds and 
bodies, and in this country those rights remain paramount. 

I mention tardive dyskinesia there, This is the worst thing to me. 
You see it everywhere in mental hospitals. You see it in the adult 
homes and the board-and-care homes, where long-term mental pa- 
tients have been sent, And it is reallv an incredible thing to see. You 
see people with their necks stretched out, permanently stretched out. 
Their bodies, their shoulders, their hips, the way they walk, are all 
very bizarre, and their tongues protude uncontrollably. Their faces 
twitch uncontrollably, and it an irreversible syndrome, There is 
nothing that can be done about it. 

It comes from high doses of phenothiazines used over long periods 
of time, and people do not know the dangers involved. You go into 
a mental hospital and you start taking these drugs, and you think 
mavbe they are helping you, and look where they can put you. It is a 
bad scene. 



PREPARED STATEMENT OF ANTHONY BRANDT 

Thank you very much for the opportunity to appear before you. 

I am a free-lance writer. Next week William Morrow and Company will publish 
a book I have written on the mental health system entitled "Reality Police." I 
spent 2% years doing research for this book, during which time I visited mental 
hospitals and mental health facilities in representative States across the country, 
interviewed numerous mental health administrators and workers at all levels 
in the system, and also talked with a considerable number of ex-mental patients. 
I also committed myself to Hudson River State Hospital in Pouehkeepsie. New 
York, to find out for mvself what it was like to become a mental patient. Arc a 
result of this research I have become familiar with the questions surrounding 
institutional drug use which are the subiect of this inouiry. My work did not 
focus exclusively on these questions, but they were an integral part of it. 

My finding are somewhat impressionistic, but they will not surprise anyone 
with experience in a mental hospital, and they are supported by a large litera- 



25 

^TvtrioTliZs, and that I needed ^£ *^*S^^d£^ 
and withdrawal, and I was very quickly admitted to the hospital on a ™luntary 
status. A foreign-graduate psychiatric resident admitted me after a 10 minute 

^Mterligning the admission papers I was taken upstairs to a ward by an aide ; 
two afdes then stripped and searched me and took my belongings. Then they led 
me to the nurse's station where the male nurse on duty in the building that 
Evening prepared an injection of mesoridazine [Serentil , which is a Phenothia- 
aine I don't know how many milligrams I was given, but I assume the dose 
was a large one. After being given the injection, I was led off to bed. 

The drug did not make me sleepy. In fact I was unable to sleep, and after an 
hour or so my mouth became extremely dry. Some 2 hours after the injection 1 
finally got out of bed and went into the hall for a drink of water. On the way 
there and back I fell down twice. I had serious difficulty controlling my legs 
and body movements generally and walking was almost impossible. I would 
reach for a wall, miss, and fall down. The drug had effectively demobilized me. 

Two things strike me as significant about this initial hospital experience : 

1. I was given this drug without any but the most superficial psychiatric 
diagnosis having been made. It was therefore nonspecific to my presumed 
"illness," and when a full diagnostic interview did take place the next 
day my drugs were changed. 

2. The drug had no effect on my thought processes but it did render me 
incapable of physical action of any kind. One of the principal side effects 
of Serentil is hypotension, especially when it is given by injection. Severe 
hypotension would explain my inability to walk. 

Taking these two things together, I cannot help but wonder whether the drug 
was primarily intended not to deal with my supposed symptoms but to im- 
mobilize me. In any case no attempt was made to monitor my reaction to the 
drug ; no one checked up on me. Furthermore no one warned me not to get up or 
try to move around. In effect I was abandoned to the drug. It was a very 
frightening experience. 

Subsequently I was given 150 mg. of Thorazine and 6 mg. of Stelazine a day 
until my discharge 11 days later, plus Artane to combat the parkinsonism which 
accompanies the use of phenothiazines. I cannot differentiate the effect these 
drugs had on me from the effect of the total hospital environment. I had planned 
to stay in the hospital a minimum of 2 weeks, but I stayed only 11 days. I left 
because the hospital was quite literally driving me crazy. The noise level was 
extremely high, there was no privacy, sleep was difficult, the regime was military 
and rigid, the physical environment was sterile, and there was nothing at all to 
do. After a little over a week I became panicky and had to leave. 

While I was there, however, I learned a great deal about the use of drugs in 
the management of mental patients. For one thing every patient on my ward 
was receiving drugs, even those who had been there 20 or 30 years and had no 
apparent symptomatology whatsoever. The level of drugging was so high that 
many patients slept 12 hours a day or more. Many of these people told me that 
they had no contact with physicians for months at a time and little or no medical 
monitoring, therefore, of drug levels. Patients also told me about the use of 
drugs as a form of punishment or coercion ; when they refused medication, re- 
fused to cooperate in other ways, threatened to break rules or did break them, 
it was common practice to inject three or four times their normal dose of tran- 
quilizer, a practice psychiatrists call "snowing," to render the patient comatose 
and make it clear to him who's the boss. I have heard dozens of stories to this 
effect from patients in mental hospitals all over the United States. It is common 
practice, and has been for at least 100 years. Once the drug was chloral hydrate 
or a bromide or even opium : now it is usually Thorazine. 

Often this occurs without medical approval. At Topeka State Hospital in 
Topeka, Kansas, for instance, I heard of cases where massive drug doses were 
administered for control purposes bv nursing personnel and the approval of a 
physician was secured afterward. Sometimes the patient is snowed and put 
into solitary confinement, usually naked, or strapped down with restraining 
sheets ; here the drugs are a chemical restraint reinforcing the message of the 
physical restraints. 



26 

It is common to administer drugs indiscriminately. An ex-patient at Bing- 
hampton State Hospital in New York told me that liquid Thorazine was ad- 
ministered to every one on his ward out of a bucket; everyone got a dose, and 
everyone got the same dose. An ex-patient who spent S years in Kings Park 
State Hospital on Long Island said he was given the same heavy dose of 
Thorazine for 5 years even though the delusions which brought him there 
lasted only 3 months. During this time he saw a physician only once a year, 
and only long enough for the physician to ask him whether he had any desire 
to go home. His reply was always, "No, I'm institutionalized," and that was 
that. 

If one cared to take the time one could duplicate stories like this thousands 
of times over. It is simply common knowledge within the mental health held 
that mental hospitals use the phenothiazines and other neuroleptic drugs indis- 
criminately to control the behavior of mental patients. No one familiar with the 
inside of a mental hospital could easily deny this. The psychiatric literature. 
speaks freely about the jnajiageme jt function of these dru g s. In the context o f 
waMjujjnjjiiatratioii tlip y ara- n man agement tool . Sid a very effective one. No 
pne_cl a_ims that the phenothiazines "cure" anyone or have any impact whatsoever 
^oji_ihe_caug es, w hatev er they may be, of jajiyjJa rticular class of mental disorder . 
AH they dolsTedllce the symptoms or some pati enla^o one knows quite how 
they work: and no one has been able vet to match specific drugs, to specific so- 
c alled "djsease" entitie s. Jhe use [as was their discovery] is almost who lly 
empirical and bears little relation ship to biochemic al theories of the source sjTf 
ps ychopathologv . The se drugs do not constitute "th erapy." " lp " l in the normal 
m edical sense of th e" term i__thes— have.- n o healing power or g»nii«-y Tli°y pre 
firgt ami fr. r pr"" g t inst'-'i'iipp^ "f «"Hni control 

I believe it is important, however, to put this fact in context. If the drugs are 
an instrument of social control, this only reflects the larger fact that the mental 
health system as a whole functions in this manner. Mental hospitals exist he- 
cause we as a society have a low level of tolerance for deviant behavior. 
People act in a disturbing manner, mumble to themselves or argue with people 
we can't see or laugh inappropriately and we get frightened and call the police or 
a psychiatrist and before too long these crazy people find themselves in a mental 
hospital. We expect the mental hospital to control or eliminate this behavior, 
and as far as we are concerned that is its primary social function. The psychia- 
trists who run the mental hospitals — and it is an historical accident that 
physicians run them — have overlaid this social function with medical concepts 
and terminology, classifying the disturbing behaviors as disease entities, and have 
attempted to treat them. In the past these so-called diseases were notoriously 
unresponsive to treatment, so the mental hospitals became huge zoos full of 
insane people, while the psychiatrists became their keepers. With the advent 
of the neuroleptic drugs, however, it became possible to control behavior at a 
distance, so to speak ; as long as people took their medicine, they could be 
safely discharged from the hospital, provided they were not too institutionalized 
to leave. The use of drugs reinforced the medical rationalizations behind which 
this process of social control took place, and led the psychiatrists to believe that 
they were truly functioning as physicians. 

The point I am trying to make is that while the abuse of drugs inside the 
mental hospitals is definitely a scandal, the abuse of the prestige and power 
of the medical sciences and profession as a mask for a system of outright social 
control may be the greater scandal. The National Institute of Mental Health 
talks complacently of the "Quiet Revolution" in the mental health field. True.^ 
the re has been a large-scale d e£i£asajtn Jbhe in-patient_p opulation i»_ 3gBliil 
lTc5spit{ilsj1 ^at"lTomrfaTion has been cut b£ Iciansl5ejalily^ 
average lengt h of stay n ationwide_ haji_i>een- -reduced to fewer Ihan 40 days. 
MofffHTnrj TesTThangps can b ejxttrilmte d to the use of neuroleptic drugs.JBuijlf--, 
hnfT7wTTmtHTnt_nn v-h hnsTebn Tiffg dTThe i ncidence" of crazy behavior seem s__to 
be"grovvtng. Morepeople — higher percen ta ges in- pj^mortion to the popiUilHpm^ 
'move into and out or tTTemental l nj^dth ^system. and while many of them g et_ 
<T f rgnteTt;" none nf-Them gets cured ^T-be" hospitals are better places in many 
respects than they used to be, but "the system as a whole is no different. Its 
function is still to control the crazy behavior we as a society cannot tolerate, and 
it still exerts that control behind the mask of medical "treatment." The only 
real change is that now the technology of control is more efficient. 

I would say that specific abuses of the drugging power are only a symptom, 
then, of a much deeper illness in the body politic: an almost savage intolerance 
for the poor, the old, the inadequate, and the insane. Rather than confront 



27 

and deal with whatever it is in our society which cannot tolerate deviance, we 
institutionalize and medicate deviant people into submission. That is the mean- 
ing of mental hospitals in our society, and that is the meaning of the manifold 
abuses one sees in them as well. 

Failing a broad shift in public attitudes, however, it seems to me obviously 
important to exert legal controls over specific drug abuses in mental hospitals 
and other institutions. I would particularly like to call attention to the dangers 
of the routine, thoughtless use of high doses of phenothiazines over long periods 
of time, which leads all too often to tardive dyskinesia. I urge everyone here 
who has not done so to visit a mental hospital sometime, preferably un- 
announced, and see for himself what tardive dyskinesia looks like. One sees it 
everywhere in mental hospitals, or in the adult homes and board-and-care fa- 
cilities which are the new mental hospitals in the community. People stumble 
along, their necks extended, shoulders and hips pitched at strange angles, tongues 
protruding and faces moving uncontrollably. Thousands of people have been 
affected by this syndrome. Everyone in mental health knows that tardive dys- 
kinesia is an irreversible syndrome yet phenothiazines continue to be adminis- 
tered in high doses over long periods of time. The hospitals have picked up the 
habit of using the drugs in this way, and like any drug habit it is a hard one 
to break. 

We need a system of legal accountability whereby the principle of parsimony 
can" be strictly .a pplied to these dangerous drugs. j t~ is not enough to rely on 
mental hospitals to police themselves. Professional standards alone have proven 
inadequate to control the abuses of medical power common in psychiatry, where 
medical and social functions overlap. Legal help or a source of appeal ought 
to be available to patients who do not want medication or feel they do not need 
it. The prescribing of neuroleptics ought to be subject to frequent periodic re- 
view by disinterested physicians. Patients ought to be fully informed about 
possible injurious side effects and the long-term danger of tardive dyskinesia. 
Ethical standards in drug research need to be considerably tighter. All of this 
will make psychiatry's role in the mental health system more difficult, but 
nobody ever said it had to be easy. We are talking about people's rights to their 
own minds and bodies nnrl in this country those rights remain paramount. 



Senator Bayii. Thank yon very much. Yonr book will be pub- 
lished when? 

Mr. Brandt. Next week. 

Senator Bayii. I am anxious to see it. 

Craig Lennox is now here. Craig, we appreciate your being here. 
Why don't you go right ahead and tell us about your experience? 

Just pull that microphone up, and forget it is there, and just give 
us a visit. Forget about all the cameras and lights, if they make you 
nervous; they make me nervous, too. 

Mr. Lennox. I just want to state the side effects that the drugs 
had on me, while I was in the psychiatric hospital. 

Senator Bayii. Could you give us a little background? I know you 
are from near Los Angeles; but could you give us a little background 
about how you got into that particular situation ? 

STATEMENT OF CRAIG LENNOX, PASADENA, CALIF. 

Mr. Lennox. I am from Pasadena. It is a large smalltown, and you 
know, when you get around with the fellows, they can lead you into 
other things you may not want to do, or you may want to do, and you 
felt like doimr it at that time of day, so Ave went out and got into some 
trouble, and I got put in jail, and from jail — inside the jail was, you 
know, it was all locked up, and I was with a bunch of strangers that 
I did not know, so I was kind of nervous. 

So I asked some — I told the doctor I had a headache, and so they 
gave me some medicine, and I was put on the psychiatric ward in jail, 



28 

and from there, they released me to Norwalk State Hospital, and I 
spent a couple of days there, and I got released on a writ of habeas 
corpus. 

While I was in Norwalk — when I first got there, they gave me the 
drugs, and I went to the bathroom, and I could not see. I was walking 
down the hall, and everything was bleary, and I felt faint. I got into 
the bathroom, and I passed out, and when I woke up, you know, I 
looked up, and there were people, you know, grabbing me, picking 
me up, and they took me and put me into bed, and I slept until the 
next morning. So the drugs took a very harsh ell'ect on me. 

Senator Bath. Do you have any idea what kind of drug that was ? 

Mr. Lennox. Not when they injected it that time; not the first 
time. It probably was Thorazine, or Prolixin. 

Senator Bayh. Did they inject it in you with a needle, give you 
pills, or what was the method ? 

Mr. Lennox. Well, when I first got there, they gave me pills, and 
then, they moved me to another ward. They gave me pills and a sirup, 
a whole bunch of pills and a sirup, three times a day. I got up in the 
morning. We took pills, and we went to the breakfast room. We ate 
breakfast. My mouth was all dry. I almost choked on the food. 

We came from breakfast, and we sat around. They had a color TV, 
a real dull dayroom. They had a Ping-pong table and everything, and 
you sit around and play Ping-pong, and watch TV. 

Senator Bayh. ISiow, you say you got into some trouble. You were 
put in jail. Then you were put in a mental ward in the jail and then 
you went to Norwalk Hospital, which is a mental institution. How old 
were you at that time ? 

Mr. Lennox. I was 19. 

Senator Bayh. You say that you were dosed with a bunch of pills 
and some sirup three times each day ? 

Mr. Lennox. Yes; the sirup was purple. It was either Thorazine 
or Prolixin. 

Senator Bayh. Did you have a chance to talk to the doctor ? Did they 
give you any tests, or anything, before they started treatment by 
popping the pills into you ? 

Mr. Lennox. When I first got there, a doctor came in ; when I was 
first admitted, a doctor talked to me, and I told him I had been in a 
psychiatric hospital before, U.S.C. Medical Center, for 2 weeks, for an 
attempted suicide. 

Senator Bayh. Did you attempt suicide ? 

Mr. Lennox. I would say yes. 

Senator Bayh. When you told that to the doctor, what did he do ? 
Did he ask you any other questions % 

Mr. Lennox. Yes; he asked me where I was from. He asked me a 
whole bunch of questions. 

Senator Bayh. Did he give you any tests, take any blood tests ? 

Mr. Lennox. The nurses took a blood test, and maybe they checked 
my high blood pressure — I mean, my blood pressure. 

Senator Bayh. Do you have high blood pressure ? 

Mr. Lennox. No. 

Senator Bayh. AH right. Excuse me ; I did not mean to interrupt. 
I just wanted to find out what had happened before they started giving 
you this regular diet of pills. 



29 

PRELIMINARY REACTION TO MEDICATION 

Mr. Lennox. So when I got in there, they gave me medicine three 
times a day. At first, when the medicine was administered to me, my 
mouth ran, a whole bunch of saliva came out. I could not stop it. There 
was almost too much to swallow. So I would stay by the trash can and 
spit it in, until my mouth was dried up completely, and my muscles 
were limp. 

Senator Bath. You did not have a problem before they started giv- 
ing you the drug ? 

Mr. Lennox. No. 

Senator Bath. Did you go along with the routine, do what they 
asked you to do, and follow the normal discipline of the hospital? 

Mr. Lennox. Yes, but when I first got there, I had a little argument 
with one of the — I did not know he was on the staff, and I had an 
argument with him, and they sent me back upstairs. They were hav- 
ing a barbecue, and I went upstairs, and this lady told me I could go 
back downstairs, so it was a hassle, so I stayed upstairs, and I went to 
sleep, and from then on, they would not let me go outside. I stayed 
inside, in the everyday routine. 

And one day they took me — I was sitting down, minding my own 
business, and they called me, and I went into the pill room, and they 
shut the door, and one of them hit me in the stomach, and the other 
two, you know, jumped on me, and they gave me a shot. I do not know 
what for. And then they strapped me down to a bed. 

Senator Bayii. How long had you been there, when they did that 
to you ? 

Mr. Lennox. I was there for about, maybe, 3 or 4 days, a week, 
something like that. 

Senator Bayii. And then what hapened after that ? Did they keep 
you strapped to the bed ? 

Mr. Lennox. Yes ; for about maybe half a day. 

Senator Bayii. Did they continue then to give you injections, shots ? 

Mr. Lennox. No ; after that, I took the medicine. I was taking it 
anyway, but for some reason, that day, they felt like they had to jump 
on somebody, so I guess they picked on me. 

Senator Bayh. You had not refused to take it, before they hit you ? 

Mr. Lennox. No; I had not refused to take it. I had complained 
about it, but I had not refused. 

Senator Bayh. Were there other patients who had been treated 
with drugs, or had been shot with drugs because they had been in- 
volved in a hassle? Was this administered in the form of punishment? 

Mr. Lennox. In my case, it was ; it was punishment. 

Senator Bayh. How about others ? Were there others that had that 
kind of experience? 

Mr. Lennox. One guy — he got up and crushed a Ping-pong table, 
and they grabbed him, and stiffened up his whole body, and they 
took him out, and. I guess, strapped him to his bed. 

Senator Bayii. Did they give him a shot of drugs, or anything? 

Mr. Lennox. Yes ; they gave him drugs. Everytime you hassle some- 
body, they give you an extra dose of drugs. 

Senator Bayh. What else happened ? 



83-303 O — 77- 



30 

Mr. Lennox. And a man came to see me, and he asked me a couple 
i f questions, you know, and then he left, you know. He was not listen- 
no- to me ; he was not paying me any attention. 

Senator Bayh. Who was this? 

Mr. Lennox. One of the psychiatrists. They changed psychiatrists, 
)/ou know — like, well, I had two psychiatrists while I was there; yes, 
wo. And the first one, he spent about maybe 3 minutes with me, and 
le did not listen. You know, his questions made sense, but when I 
mswered them, he did not listen, and he got the wrong impression. 
And he left. 

FILED WRIT OF HABEAS CORPUS 

And then this lady came in and told me that if I felt I was being 
held there illegally or unjustified, that I could file for a writ of habeas 
corpus, so that it what I did, and then I got out. 

Senator Bayh. How do you feel now ? 

Mr. Lennox. I feel fine. 

Senator Bayh. What are you doing now ? 

Mr. Lennox. I have a lot of applications in and everything. I have 
been waiting around for a job. 

Senator Bayh. You arc t rying to get a job ? 

Mr. Lennox. Yes. 

Senator Bayh. What would you like to do ? 

Mr. Lennox. Delivery. 

Senator Bayh. How far along did you get in school ? 

Mr. Lennox. A diploma. 

Senator Bayh. You graduated from high school ? 

Mr. Lennox. Yes. 

Senator Bayh. Where did you go to school ? 

Mr. Lennox. PHS. 

Senator Bayh. Pasadena High School? 

Mr. Lennox. Yes. 

Senator Bayh. T hope you get the job. 

Do you feel you have anything working on you now? That you feel 
a need for drugs ? 

Mr. Lennox. No; I have not taken drugs for a longtime. 

Senator Bayh. I appreciate your giving us your thoughts on this, 
rhey will help us get a better understanding. 

Did you have a trial, or anything like that, as a result of the act 
that put you in jail in the first place? 

Mr. Lennox. Yes. 

Senator Bayh. How was that disposed of? Are you on probation? 

Mr. Lennox. Yes. 

Senator Bayh. How long will that last ? 

Mr. Lennox. Two years. 

Senator Bayh. Is that creating a problem with your obtaining a job? 

Mr. Lennox. Not really. I can do odd jobs, you know ; I do not have 
to sign any papers. 

Senator Bayh. You want to work, right? 

Mr. Lennox. Yes; of course. 

Senator Bayh. From what you say you really understand that you 
should not have become involved in the altercation that sent you to 
jail in the first place. Is that accurate ? 

Mr. Lennox. Yes. 



31 

Senator Bayh. We have run into a number of experiences where 
young men like yourself make that first mistake. Then when they want 
to get a job, and go ahead and lead a normal life, the fact that they 
made the first mistake is used by prospective employers to keep them 
from getting a job. I wondered whether you had run into that. 

Mr. Lennox. You say, what ? 

Senator Bayh. I just wondered whether you have run into people 
who have jobs available; and then when you apply, and they find out 
you are on probation, they say, "well, no, we do not need you." 

Mr. Lennox. Yes ; that is true. 

Senator Bath. That is one of the real problems of our society. If a 
fellow makes a mistake, it is awfully hard to get away from it and go 
ahead and live a normal life. The important ingredient, a job, and 
having the opportunity to provide a living for yourself is seriously 
limited. People are afraid to let you have a chance to make up for that 
mistake. 

Mr. Lennox. Yes. 

Senator Bayh. Thank you very much. I appreciate your taking the 
time to be with us here. 

Mr. Hudson, we appreciate your being here. 

STATEMENT OF WADE HUDSON, NETWORK AGAINST PSYCHIATRIC 
ASSAULT, SAN FRANCISCO, CALIF. 

Mr. Hudson. Yes, thank you. My name is Wade Hudson. I live in 
San Francisco. I work on the bimonthly publication. Madness Net- 
work News, and coedited the book. Madness Network News Reader, 
published by Glide Publications. 

I have worked in psychiatric institutions, and I have been locked 
up in psychiatric institutions, and I speak here today representing 
NAPA, the Network Against Psychiatric Assault. 

I might also add, for your information, and the benefit of people 
here, that I also had the pleasure of working on a movie, a documen- 
tary entitled "Hurry Tomorrow" which will be released next week, 
with Craig Lennox, as well as several other people. It was filmed in 
the hospital where he was locked up. Most of the footage was actually 
filmed inside a State hospital, so people would be able to see with their 
own eyes what it is like. 

Senator Bayh. What organization, or what function have you been 
involved with there in the bay area? We have had experience with 
Roger Smith in the center over in Marin County; and Huckleberry 
House in San Francisco itself. I have learned a lot from looking at 
some of the programs. What part of the program are you involved in, 
specifically? 

Mr. Hudson. Well, I am familiar with Huckleberry House, but for 
a year and a half, I have worked with the Network Against Psychi- 
atric Assault, which is primarily engaged in community education, 
and efforts to push for changes in oppressive conditions in institutions, 
and so forth. 

HALLUCINOGENIC EXPERIENCES 

I would like to say several words about my own experience. If any- 
one was ever crazy, I was. My freakout lasted for several months, 



32 

before I returned to solid ground. During this time, I experienced 
both terror and ecstasy, as I never had before, nor have I since. Most 
vividly, I recall holding the hand of a Japanese man in St. Francis 
Hospital, because I felt that he could best understand and support me 
as we experienced the explosion of a nuclear bomb in San Francisco 
as the planes roared overhead. 

My roommate at St. Francis, I was convinced, was J. Edgar Hoover 
himself. For days, I experienced the sensation of being on worldwide 
television as FBI agents followed me around attempting to harrass 
and frighten me into renouncing my most profound convictions. The 
fate of liberty and freedom throughout the world rested in my hands 
as millions watched my drama on TV; if I survived, they would be 
inspired; if I failed, they would resign in despair. 

In May of 1971, very few people realized what Richard Nixon and 
the Plumbers and the rest of that gang were up to. Myself, I sensed 
totalitarianism around the corner and was extremely frightened. I 
also felt alone and helpless. The more frightened I became, the more 
I demanded that my friends prove that they would help me, that 
they were trustworthy. But the more I demanded, the more my friends 
backed away, making me more frightened and alone. 

This deadly spiral, which included many positive experiences of 
the highest order, such as participating in two black worship services, 
reached one peak when I physically attacked a close friend whom I 
suspected of being an FBI agent. He and others subdued me and 
persuaded me to go get some Thorazine. 

As we left the house, I smeared ketchup on my face so that the 
people watching on television would believe that I was physically 
injured and was being taken to a medical hospital for emergency care 
so that if the FBI intervened and apprehended me, they would be 
exposed as evil men interfering with critical medical care. 

My 4 days at St. Francis Hospital were, I believe, tragically typical. 
Two men in white coats greeted me, more or less without talking, and 
put me in locked seclusion. I spent 2 days in isolation. No one came in 
to talk with me for more than 30 seconds at a time, and then only to 
give me my food or my drugs. The drugs, what they call medication, 
came, as they often do. in all sorts of shapes and colors, in my case, 
four or five different pills at one time. 

At first, I only pretended to swallow them and afterwards flushed 
them down the toilet. But they soon noted my tactic and insisted that 
I swallow them in their presence. Knowing that the needle would be 
the result if I refused, I consented. 

After 4 days, for whatever reason, they decided to release me. Dur- 
ing this time, the only real human contact or warmth I received was 
from fellow inmates and friends who visited. The staff was very 
professional, very busy, and very impersonal, and very neatly dressed 
in clean, white uniforms. 

Before letting me go, however, they forced on me one last thera- 
peutic benefit, a shot of Prolixin in my buttock, administered by a 
long-haired hippie-looking doctor who no doubt believed in better 
living through chemistry. 

Senator Bath. May I venture to ask a couple of questions here? 
How do you know it was Prolixin? 



33 

Mr. Hudson. Because I got a copy of my discharge summary — they 
would not give me a copy of my whole records, and it stated that. 

Senator Bath. It stated that? 

Mr. Hudson. Correct. 

Senator Bayh. How does one describe a long-haired hippie-looking 
doctor ? 

Mr. Hudson. He had a beard, he had long hair, and he had 
shabby — . — 

Senator Bayh. I must say, you look like you are a very substantial 
witness, and you have long hair. Just because a person has long hair, 
I would not want to describe them as unable to do the job. 

Mr. Hudson. Oh, for sure, I am making no disparaging comments. 
I am just describing the situation. 

Senator Bayh. I want to state that if we go back and reread what 
you just said, and I think, maybe, one could get that inference. 

REACTIONS TO PROLIXIN 

Mr. Hudson. Well, whatever. 

Prolixin, I hope you know, is the most terrifying psychiatric drug 
on the market. Suspended in a special solution, a phenothiazine much 
like Thorazine, it is time released so that it works on your body and 
mind for weeks at a time. One injection every week or two, and you 
have a nation of zombies, easily controlled. 

All their drugs slowed me down a bit. I reckon they did not give 
me enough to wipe me out. But otherwise I was basically the same a s 
w hen I went in, very freaked oiv t. After 10 days or so, however, the 
effects of the Prolixin began building up in my system and my body 
started going through pure hell. It is very hard. to describe the effects 
of this drug and others like it. That is why we use strange words like 
zombie. But in my case, the experience became sheer torture. 

Different muscles began twitching uncontrollably. My mouth was 
like very dry cotton no matter how much water I drank. My tongue 
became all swollen up. My entire body felt like it was being twisted 
up in contortions inside by some unseen w T ringer. And my mind became 
clouded up and slowed down. 

Before, I had been reasoning incorrectly, but at least I could rea- 
son. But most disturbing of all was that I feared that all of these 
excrutiating experiences were in my mind, or caused by my mind, a 
sign of my supposed sickness. 

Finally, with a friend, I returned to the mental health center where 
I received some Cogentin, a drug commonly given to counteract the 
side effects of phenothiazines. No one gave me any of this antidote 
when they shot me up with Prolixin. No one told me or my friends 
to ask for Cogentin if the Prolixin freaked out my body, which hap- 
pens frequently. No, they merely shot me up and sent me out the door 
and wished me luck. 

So, after days of agony, I returned desperate for help. I took the 
Cogentin and within 10 minutes an incredible wave of relaxation flowed 
through my body. That sense of relaxation is indescribable, so I will 
simply say that it was one of the most marvelous experiences of my life. 



34 

Drugs like Cogentin do not totally erase the effeets of drugs like 
Prolixin. In fact, they have their own negative effects. But at least 
they do decrease some of the more unbearable immediate effects. 
Nothing makes me more angry about my experience with St. Francis 
Hospital than the fact that they inflicted this suffering without a word 
of warning, even though my experience is very common. 

But what if I had been warned? What if I had been given Cogentin 
from the start? "Would the forced drugging of someone flipped out 
like I was be justified under these circumstances? 

The most common argument used to justify the forced drugging of 
people labeled mentally ill is that they are not able to make decisions. 
But I was clearly able to make decisions. I flushed the drugs down the 
toilet. Was that irrational? Or was the doctor who shot me up irra- 
tional? In fact, I made all sorts of decisions. 

I may even have made the decision to go crazy, to escape from un- 
bearable pressures; to manipulate people into exposing their true feel- 
ings about me; to force mv dilemma to a head. I cannot really explain 
it, but I sense that on a semiconscious level, I may have decided to go 
crazy. I know for certain that I decided to go sane. Locked in seclusion 
in Dallas, threatened with indefinite incarceration, I decided that many 
of my fears were imaginary and that I had best shape up and return 
to the normal world, if I wanted to get out, which I then proceeded 
to do. 

SELECTIVE IRRATIOXALITY 

So my irrationality was selective. In certain respects. I remained 
rational as usual, and in other respects, I was superrational. I per- 
ceived all sorts of realities normally ignored or hidden. So who is 
to say that I was unable to make decisions? 

In fact, are we not all rational, irrational, and superrational all 
of the time? Do not all of us imagine things that are not really hap- 
pening? Do not all of us have unjustified fears? 

So who can say that another is freaked out to the degree to justify 
the chemical rap e of his or her mind or body, because rape is what it is, 
the 1'orcible intrusion into the sacredness and privacy of another per- 
son's body. mind, and spirit. Many rapists claim that their victims bene- 
fit from their rape. Some judges have even pretty much ruled the 
same. Consider, for a moment, a 21-year-old virgin woman who, out of 
sheer ignorance, is irrationally afraid of sexual intercourse. Suppose, 
also, that it was proven that 53 percent of 21-year-old virgin women 
who, out of sheer ignorance, are irrationally afraid of sexual inter- 
course, no longer irrationally fear sexual intercourse after being raped. 
Would rape, under those circumstances, be justified? Could rape ever 
be justified? 

The law authorizes the alteration of another person's body without 
consent when that person is clearly and demonstrably suffering from 
a physical affliction which prevents a decision being made — for exam- 
ple, being unconscious after an automobile accident. But so-called 
mental illness is no phvsical disease whose presence or absence can be 
clearly and demonstrably proven with any significant degree of sci- 
entific reliability, because it does not exist. 

The whole legal concept of competency, I submit, should be limited 
to situations related to scientifically proven phvsic al impairment . So- 



35 

called psychiatric incompetency is sheer conjecture and should never 
be a rationale for chemical rape. 

PSYCHIATRIC TREATMENTS UNPREDICTABLE 

Senator Bayh, I urge you to realize that the most important fact 
before you is that all psychiatric treatments are essentially experi- 
ments, the results of which are incredibly unpredictable. Drug reac- 
tions, for example, vary widely from person to person, and perhaps 
from ethnic group to ethnic group. Tardive dyskinesia, permanent 
brain damage, was not recognized in drug company advertising until 
many thousands of people were afflicted with this serious brain dam- 
age. Who knows what other damage is being inflicted on people by 
these extremely powerful drugs ? 

Neither have the alleged benefits of these drugs been scientifically 
demonstrated. One recent study, for example, found that the people 
who had received placebo pills in the hospital were doing better after 
discharge than were the people who had received the actual phenothi- 
azines. 

I consider forced drugging an unconstitutional and unethical vio- 
lation of freedom of thought and invasion of privacy. Therefore, no 
matter how wonderful any drug they might create, no matter if the 
drug were proven to do more harm th an good, which" is not now the 
case? no jn atter if you ancl theCoiigre^s„wer e able to devise a m irac- 
u lous way to limit foiTed _^nigglJlgLi^L t ^"Q se cases whe r^J}£ne£cIaXje : ~ 
s uits were re a sonably c ^rlaitu^and I do not believe that any such pre- 
ve ntive ihlj clianis m will ever iae devise d because p ower tends Umn^ruptT 
^ c jJ ^ a J^ r ^ ai I^o^Ig£-^bsoluleiy. corrupts, regardless, under any and 
alHulxumstances — no pers on should hold the power to jdJ^r-JioJuabTy 
th e mind and body of an other person. 

Thank you. That conipletes- my statem ent. 

Senator Bayh. Thank you, Mr. Hudson. Your organization is try- 
ing to prevent the abuse and misuse of drugs, as far as their application 
to inmates who have been admitted or incarcerated? 

Mr. Hudson. Yes ; and I would like to make a point of submitting 
this statement and exhibits for the record, if I may. 

Senator Bayh. Yes; thank you, we will enter them in the record at 
this point. 

PREPARED STATEMENT BY WADE HUDSON 
Institutional Drug Abuse 

Mr. Chairman and Members of the Subcommittee on Juvenile Delinquency, my 
name is Wade Hudson and I speak representing NAPA — the Network Against 
Psychiatric Assault. My experience with psychiatry began more than ten years 
ago, at the age of twenty, as a psychiatric orderly in a small unit closely affiliated 
with Southwestern Medical School in Dallas. Texas. Following this work, I re- 
turned to college and studied psychology : two years while completing my under- 
graduate degree at the University of California and two years graduate study 
at the Pacific School of Religion. During this time. I worked in a number of 
mental health and related jobs : one hospital, one half-way house, and several 
churches as a counselor and youth worker. In 1971, I was twice locked up in 
psychiatric institutions, labeled paranoid schizophrenic: for four days in St. 
Francis Hospital in San Francisco and for two weeks in Woodlawn Hospital in 
Dallas, where I had previously worked as an orderly. In 1!»72. I began working 
on Madness Network News, and later that year worked as co-editor of the Mad- 
ness Network News Reader, recently published by Glide Publications. During 



36 

late 1973 and early 1974, I again worked as a mental health worker— this time 
in the Crisis Clinic of a Community Mental Health Center. And in early 1974, a 
few other people and myself formed NAPA, which has been my full-time commit- 
ment for more than 18 months now. 

Throughout this 11 year period, my overwhelming concern has been the quality 
of human experience, and related questions of social justice and the unjustified 
exercise of power. I have observed, and experienced personally, many incidents 
which disturb me profoundly. I welcome the opportunity to share these 
experiences. 

If anyone was ever crazy, I was. If the label paranoid schizophrenic has any 
validity, and I don't believe that it does, I was a paranoid schizophrenic. My 
freak-out lasted for several months before I returned to solid ground. During 
this time, I experienced both terror and ecstasy as I never had before, nor have 
I since. Most vividly, I recall holding the hand of a Japanese man in St. Francis 
Hospital because I felt that he could liest understand and support me as we 
experienced the explosion of a nuclear bomb in San Francisco as the planes 
roared overhead. My roommate at St. Francis, I was convinced, was J. Edgar 
Hoover himself. For days, I experienced the sensation of being on world-wide 
television as FBI agents followed me around attempting to harrass and frighten 
me into renouncing my most profound convictions. The fate of liberty and free- 
dom throughout the world rested in my hands as millions watched my drama on 
TV : if I survived, they would be inspired ; if I failed, they would resign in 
despair. 

In May of 1971, very few people realized what Richard Nixon and the Plumbers 
and the rest of that gang were up to. Myself, I sensed Fascism around the corner 
and was extremely frightened. I also felt alone and helpless. The more fright- 
ened I became, the more I demanded that my friends prove that they would 
help me, that they were trustworthy. But the more I demanded, the more my 
friends backed away, making me more frightened and alone. This deadly spiral, 
which included many positive experiences of the highest order, such as partici- 
pating in two black worship services, reached one peak when I physically at- 
tacked a close friend whom I suspected of being an FBI agent. He and others 
subdued me and persuaded me to "go get some Thorazine." As we left the house. 
I smeared ketchup on my face so that the people watching on television would 
believe that I was physically injured and was being taken to a medical hospital 
for emergency care so that if the FBI intervened and apprehended me, they 
would be exposed as evil men interfering with critical medical care. 

My four days at St. Francis Hospital were, I believe, tragically typical. Two 
men in white coats greeted me, more or less without talking, and put me in 
locked seclusion. I spent two days in isolation. No one came in to talk with me 
for more than 30 seconds at a time, and then only to give me my food or my 
drugs. The drugs — what they call medication — came, as they often do, in all 
sorts of shapes and colors : in my case four or five different pills at one time. 
At first. I only pretended to swallow them and afterwards flushed them down the 
toilet. But they soon noted by tactic and insisted that I swallow them in their 
presence. Knowing that the needle would be the result if I refused, I consented. 

After four days, for whatever reason, they decided to release me. During this 
time, the only real human contact or warmth I received was from fellow inmates 
and friends who visited. The staff was very professional, very busy and very 
impersonal — and very neatly dressed in clean, white unforms. Before letting 
me go. however, they forced on me one last "theapeutic" benefit : a shot of 
Prolixin in my ass — administered by a long-haired hippie-looking doctor who no 
doubt believed in better living through chemistry. 

Prolixin, as I hope you know, is the most terrifying psychiatric drug on the 
market. Suspended in a special solution, a phenothiazine much like Thorazine, 
if is time released so that if works on your body and mind for weeks at a time. 
One injection every week or two, and you have a nation of zombies, easily con- 
trolled — especially if the threat of incarceration can coerce them into appearing 
for their regular injection. 

All their drugs slowed me down a bit — I reckon they didn't give me enough 
to wipe me out — but otherwise I was basically the same as wben I went in : 
very freaked out. After 10 days or so. however, the effects of the Prolixin began 
building up in my system and my body started going through pure hell. It's very 
hard to describe the effects of this drug and others like it. That's why we use 
strange words like "zombie." But in my case the experience became sheer torture. 
Different muscles began twitching. My mouth was like very dry cotton no matter 



37 

how much water I drank. My tongue became all swollen up. My entire body 
felt like it was being twisted up in contortions inside by some unseen wringer. 
And my mind became clouded up and slowed down-before I had been reasoning 
incorrectly, but at least I could reason. But most disturbing of all was that 1 
feared that all of these excruciating experiences were in my mind, or caused u> 
my mind— a sign of my supposed sickness. 

Finally with a friend, I returned to the mental health center where I re- 
ceived some Cogentin— a drug commonly given to counteract the side effects ot 
nhenothiazines. No one gave me any of this antidote when they shot me up witli 
the Prolixin. No one told me or my friends to ask for Cogentin if the Prolixin 
freaked out mv body, which happens frequently. No, they merely shot me up 
and sent me out the door and wished me luck. So, after days of agony, I returned 
desperate for help. I took the Cogentin and within ten minutes an incredible 
wave of relaxation flowed through my body. That sense of relaxation is inde- 
scribable, so I'll simply say that it was one of the most marvelous experiences 
of my life. Drugs like Cogentin do not totally erase the effects of drugs like 
Prolixin — in fact they have their own negative effects. But at least they do 
decrease some of the more unbearable immediate effects. Nothing makes me 
more angry about my experience with St. Francis Hospital than the fact that they 
inflicted this suffering without a word of warning, even though my experience 
is very common. 

But what if I had been warned? What if I had been given Cogentin from the 
start? Would the forced drugging of someone nipped out like I was be justified 
under these circumstances? 

The most common argument used to justify the forced drugging of people 
labeled mentally ill is that they are not able to make decisions. But I was clearly 
able to make decisions: I flushed the drugs down the toilet. Was that irrational? 
Or was the doctor who shot me up irrational? In fact, I made all sorts of 
decisions. 

I may even have made the decision to go crazy — to escape from unbearable 
pressures : to manipulate people into exposing their true feelings about me ; to 
force my dilemma to a head in order to enable some basic change to take place. 
Who knows. I can't really explain it, but I sense that on a semi-conscious level, 
I may have decided to go crazy. I know for certain that I decided to go sane. 
Locked in seclusion in Dallas, threatened with indefinite incarceration, I decided 
that many of my fears were imaginary and that I had best shape up and return to 
the normal world, which I then proceeded to do. 

So my irrationality was selective : in certain respects, I remained rational as 
usual ; and, in other respects, I was super-rational — I perceived all sorts of 
realities normally ignored or hidden. So who is to say that I was unable to make 
decisions. 

In fact, are we not all rational, irrational and super-rational all of the time? 
Don't all of us imagine things that aren't really happening? Don't all of us 
have unjustified fears? I know that I do now, that I did before I freaked out, 
and that I always will. I had freaked out before, I have freaked out since, and 
I will freak out again. We all do — to one degree or another — all of the time. 
It's all a matter of degree, and there's no way to measure the degree with any 
significant degree of accuracy. So who can say when another is freaked out to 
the degree to justify the chemical rape or his or her mind and body. 

Because rape is what it is: the forcible intrusion into the sacredness and 
privacy of another person's body, mind and spirit. Many rapists claim that their 
victims benefit from their rape. Some judges have even pretty much ruled the 
same. Consider, for a moment, a virgin wife who, out of sheer ignorance, is irra- 
tionally afraid of sexual intercourse. Suppose also that it was proven that 53% 
of virgin wives who, out of sheer ignorance, are irrationally afraid of sexual 
intercourse, no longer irrationally fear sexual intercourse after being raped by 
their husbands. Would rape under those < ircumstances be justified? Could rape 
ever be justified? 

The law authorizes the alteration of another person's body without consent 
when that person is clearly and demonstrably suffering from a physical affliction 
which prevents a decision being made — for example, being unconscious after an 
automobile accident. But so-called "mental illness" is no physical disease whose 
presence or absence can be clearly and demonstrably proven with any signficant 
degree^ of scientific reliability— because it doesn't exist. Rather, the medical 
model is a mythological, or metaphorical way of describing human realities which 



38 

can far better be described in plain English. "Psychosis" and "neurosis" and that 
whole system of thinking are mystifications used by psychiatrists to obscure and 
legitimize the brutalities they impose on people. 

The whole legal concept of competency, I submit, should be limited to situa- 
tions related to scientifically proven physical impairment. So-called psychiatric 
incompetency is sheer conjecture and should never be a rationale for chemical 
rape. 

Mr. Chairman and members of the subcommittee, I urge you to realize that 
the most important fact before you is that all psychiatric treatments are essen- 
tially experiments, the results of which are incredibly unpredictable. Drug re- 
actions, for example, vary widely from person to person, and perhaps from 
ethnic group to ethnic group. Tardive dyskinesia was not recognized in drug 
company advertising until many thousands of people were afflicted with this 
serious brain damage. Who knows what other damage is being inflicted on people 
by these extremely powerful drugs. Neither have the alleged benefits of tnese 
drugs been scientifically demonstrated. One recent study, for example, found 
that the people who had received placebo pills in the hospital were doing better 
after discharge than were the people who had received the actual phenothiazines. 

Many people before this committe have been and will be suggesting that re- 
forms be implemented to safeguard against abuses of the power to administer 
psychiatric drugs forcibly. But I submit that forcibly subjecting people to 
pseudo-medical experimentation is unethical and inherently an abuse. Further- 
more, I also consider forced drugging an unconstitutional violation of freedom 
of thought and invasion of privacy. Therefore, no matter how wonderful any 
drug they might create, no matter if the drug were proven to do more harm than 
good, which is not now the case, no matter if you and the Congress were able 
to devise a miraculous way to limit forced drugging to those cases where bene- 
ficial results were reasonably certain, and I don't believe that any such pre- 
ventive mechanism will ever be devised — regardless, under any and all circum- 
stances, no person should hold the power to alter forcibly the mind and body 
of another person. 



39 



[Exhibit No. 3] 



I1APA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

629 Suiter Street. San Francisco, California 94102, (415) 771-3344 

MlS C tLLANouUS PlHjjOImmL Tc.bTIMuNY 

Permission is granted to reprint the following testimonies, except 
perhaps for the KPFA excerpts. 



I) After breakfast, a huge rolling tr^y o 
out into the hall, and the obese nurse called 
All the unfortunate zombies on the ward trudge 
pills and blood pressure readings. The really 
down in a closed off room for electro-shock. T 
little trick was the most evil looking of all. 
orange tabs of straight Thorazine, which broug 
bling vegetation- within twenty minutes. 

One does not a rgue or think in this st 
y ou ever~~argued with a r a disri or~a~ yam"7 They d 
tTie s -;me time~i I was perspirinr so profusely,a 
that I began to think that I'd just go on swea 
mouth got so dry that nothing would quench its 
my tongue cracked wide open in a vicious painf 
bled incessantly , with a palsy closely resembli 
My skin turned a dead -yellow-gray color, My ey 
tive to light, and so did all t he skin all ove 
slow motion, in a heavy fog~i caTt fully aware o 
note of every comment I made, and every change 



f medicines was wheeled 
out "Meoication Time", 
d obediently over fcr 
big losers got strapped 
he equipment for that 

I was given two chubby 
ht me to a state resem- 

ate. After all, have 



on ' t answer back. TTt 



nd so continuously 
ting till I ciied. My 
thirst. Eventually, 
ul way. r-ly nanus trem- 
ng Parkinson's disease, 
es bec ame super-s ensi- 
r my body. I move d in 



f the nurses, who tock 
of mood . . . 



Franeie Schwartz 
excerpted from >CLY CULK.T 
II) '..hat happened in my case is that I received Mellaril, a tran- 
quillizer , now called an anti-psychotic drug. This was forced drugging 
in the sense that I wasn't consulted before it was administered nor 
told of possible side-effects. I wasn't even told I was noing to be put 
on medication so it came as a total surprise to me when I heard an at- 
tendant yell, "Brewer, come take your medicine." Well, I took my 
medicine. I had no choice. The attendant didn't take her eyes off me 
until the pills were swallowed. 

As a result of this medicaticn I fainted ana was carried to 
my bed. My condition was described at the time as very serious. It 
seems I was the victim of an OD and my blood pressure had dropped 
dangerously low. I was immediately given two shots of caffiene- a 
procedure made difficult because of my inability to double up my 
fist for intravenous shots. While I was getting the shots the doctor 
ask3d me if I had thought about what he had said about my rebelling. 
He asked it in a tone of voice as if to say, "Have you luarned your 
lesson yet, Miss Brewer?'.' 



Jimmie Brewer 



40 



nAPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

629 Sutter Street, San Francisco, California 94102. (415) 771-3344 

III) Chemotherapy-This subject is probably the most important, 
because it involves thousands of patients daily, on a statewide 
basis. At all state and county mental health facilities, patients 
are forced to take drugs. This is not iexceptional in any way, but 
routine, daily practice. 

My own experience with these practices stems from my employ- 
ment as a staff psychiatrist at the Marin Community Mental Health 
Center from March 1972 to April 1974. For a portion of this time, 
I was Chief of the Crisis 5ervices. I finally resigned cause I could 
not in good conscience continue to be a part of the forced therapy 
and forced drugging which was routine. 

In. any given day, many patients are brought in on 72 hour 
holds . (Lanterman-Petris-5hort ) . Aside from the fact that in my 
experience, these holds are usually grossly inappropriate and in 
violation of the law, it is routine for these patients to be placed 
on medication. This is usually a tranquillizer, most often one of the 
phenothiazines. 

These drugs are given orally, but if the patient refuses them 
by mouth, an injection will be ordered and given by force. It is. 
also not uncommon for a special form of one of these tranquillizers, 
prolixin enanthate, to be given by forced injection. This medica- 
tion is specially formulated to continue its action for 2 to 3 weeks. 

Thus, long after the individual may be free of forced psy- 
chiatric treatment, the drug will continue to be tranquillizing the 
individual and thereby, in my opinion, invading on his person and his 
privacy. I believe that forced drug treatment is an assault on the 
individual that is unjustified. It is widsly known that the highly 
unhealthy relationship between the pharmaceutical industry and the 
mecical community, in which drug companies test their own drugs for 
safety, and in which the drug companies give gifts and favors to 
doctors in a not so subtle attempt to influence their drug prescribing 
habits, leads to insufficient attention to potentially dangerous 
side effects of drugs. 

Given this situation, the taking of any drug is a personal act 
involving decision making which must remain (or in some cases become) 
totally voluntary, as with any other medical procedure. I recommend 
that all drug therapy require the voluntary consent of the patient, 
with particular emphasis on the forced injection of long acting 
tranquillizers. 

p.s. Besides State and County mental health facilities, the 
California Prison 5ystem is virtually overflowing with the various 
drugs administered to prisoners. This is a whole area which should 
receive the most serious attention. 

Lee Coleman, M.L. 



41 



nAPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

629 Sutler Street. San Francisco, California 94102, (415) 771 -3344 

IV) In 1964, the psychiatrist I was seeing started me on Stelazine. 
He told me at one point that I would have to be on it for life. I 
tried to taper down and stop five or six times in the ten years that 
I took the drug. Until this last and final time, my reasons were: 
1 )merely that I abhorred the idea of being controlled by a chemical, 
and 2) an eye condition which I shall describe later. 

• All the previous tries ended in failure because I cuuld not 
cope with the physical and emotional changes that going off the drug 
brought on. One time I had a very heavy feeling in my chest and was .. 
dragged out the entire day. Another time my stomach felt so continu- 
ously torn up that I felt like I was being tortured. I had special 
difficulty trying to eat, which necessitated going slowly and taking 
deep breaths between each bite. Always the salivation in my mouth 
increased and was so strange to me that it was an ever present annoy- 
ance. Emotionally, when anger and crying surfaced, Iv as so unused to 
them that I felt I wasntt myself and had to return to a drug induced 
complacency in order to function. Each try consisted of at least four 
or five days of being entirely drug free. Each time I gave up, I 
thought I would never try again, and I truly felt it was an addiction. 

From <jbout the fifth year of taking Stelazine, I began having 
an eye trouble. My eyes would "go out", as I called it, about four times 
a. week, usually about four or five in the afternoon. Prolonged bouts 
of reading, movie viewing, and long drives in the country initiated 
it almost invariably. Everything in my visual field became pinpointed 
and outlined;and if I looked at a blank wall, it was full of patterns. 
Mlso my eyes kept travelling upwards. If I closed my eyes and put my 
hands on my eyelids, I could feel my eyeballs fluttering rapidly and 
again there were patterns but in colors and changing so rapialy that 
my brain couldn't keep up with what I was seeing . I. eedless to say I 
found this so annoying that I found it impossible to be sociable, 
would not dare drive my car, and always hurried home to lie down, 
bec.iuse I gained relief only by falling asleep. 

The^ p_s~ychiatrist did not kn ow if this condition was caused 
by the Stelazine a nd asked me , " If _JL±_ i s , isn ' t ~that _lit tle enoug n' 
Tfo pHy f or an even disposition?". I went to an ophthalmologist and 
FTaci an examination and to a neurologist and had an EEG. Negative. 
Iwas living in the East and even considered going to Boston and con- 
sulting an eye specialist. 

oeptember 13, 1973, I had what seemed to me final proof th.it 
hte eye condition was caused by the Stelazine. I tried to commit 
suicide by taking an overdose of the drug. The attempt failed, out 
by mid-afternoon of the next day, my eyes were so acutely troublesome 
that I h_'d to leave work early. 

In November, I started Feeing a therapist who encouraged me 
to go off the drug, this time I tapered off at an extremely slow pace. 
At the start I was on five mg. a day. By March 15, while on two mg.. a 
day, I was beginning to notice that I was changing and coming alive. 
I was no longer blocking out existence by oversleeping, which had 
been one of my toughest problems. 

On April 26, (only four days after bein completely drug 
free), I failed again and went back on the pills .unidst a turbulent 
situation which included trying to hospitalize myself. I had become 



42 



ndPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

629 Suiter Street. San Francisco. California 94102, (415) 771-3344 



IV con 

"Madne 
on the 
a real 

positi 
crisis 
will g 

paraly 
lieve 
upside 
my the 
One Fr 
needin 
and ta 

I have 
genera 
for te 
nature 



td ) supe 

Two 
ss l\letw 

drug a 

fight . 
My 
on?" ( T 

I was 
et it." 
• The 
sis of 
th:.t I 

down t 
rapist, 
iday ni 
g to ta 
Iked ou 
My 

an und 
1 I fee 
n years 

and ha 





r agitated and kept saying, "My head isn't on straight", 
weeks later after reading Dr. Caligari's article in the 
ork News", I told myself I w^s a fool if I continued 
fter what I had read, and I became determined to put up 

therapist said, "Do you take responsibility for this 
he List time I had blamed him for not recognizing the 
heading for.) I said, "Yes I do, and if I need help, I 



re f 
such 

waul 
ryin 
but 
ght, 
Ik, 
t lo 
eyes 
erly 
1 as 
. 1 
ve a 



olio 

an 
d ma 
g to 

I r 

aft 
in m 
ud t 

are 
ing 

if 
am f 

gen 



wed 
unbe 
ke i 
fin 
eali 
er t 
y im 

hi 
fin 

feel 

1 h=. 
unct 
uine 



a mon 
arabl 
t. Se 
d som 
zed h 
alkin 
agina 
m for 
e now 
ing t 
d aw.i 
ionin 
lust 



th o 
e na 
vera 
eone 
e co 
g to 
tion 

hal 
, I 
hat 
kene 
g nu 

for 



f me 
ture 
1 ti 

to 
uldn 

f ou 

I 3 
f an 
am 5 
it i 
d af 
ch m 

lif 



ntal 
tha 
mes , 
talk 
't b 
r di 
at a 
hou 
tela 
s te 
tcr 
ore 
e. N 



anguish and emotional 
t it was difficult to be-.v. . 

I almost turned the town 

to. I wanted to talk to 
e a round the clock nurse. 
fferent friends and still 

friend down in a chair 
r . 

zine free, and when I cry, 
mporary and cathartic. In 
having just been asleep 
in keeping with my true 
eed I say more? 

Bryna Frank, 7/ 74 



V) In May 1972, I entered Hoch psychiatric annex of Pilnrim 
State Hospital in dellevue , N . Y . , as a volunteer patient. My mental i 
state was one where I believed I was God; it was a very creative, 
non-violent . and euphoric state. I was aw^re even then that everyone 
has a right to that experience. I upset ny parents, however, in my 
attempts to share my trips with them. To humor them, as well as due 
.to curiosity about my state of mind, I volunteered to enter a psy- 
chiatric clinic. I did not see myself as "sick", but I was eager to 
share and explore my state of mind with others whom I thought could 
direct me creatively, due to their prof ession : psychiatry .Ycu see, I 
was also in a very trusting, naive, rather defenseless state. 

My viewpoint on psychosis or any other l.ibel implying 
mental illness is that it is an unbal3nced state of mind causec by 
repression, frustration, alienation and other cruelties of our social 
environment, and can only be cured by a loving, compassionate environ- 
ment. Many other stated of mind ( i .e .-"euphoria" ) are labeled psychotic 
because those who do the labelling are also those who are responsible 
for society's cruelties. 

My abuses at the hospital were: 

1) I had to <sign myself in as a voluteer patient on » aoc- 
ument which stated that I have a right to request a release any time 
after I sign the document. This wording is tricky, and unfair to the 
patient. I did request my release the next day, and my psychiatrist 
said I do have the right to request my release, but it is still up 
to the hospital to grant it. 

2 ) Actually , i I was free to leave; there were no fences 
around the grounds. But I was in the middle of suburban Long Island 



43 



nAPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

629 Sutler Street, San Francisco. California 94 1 02, (4 1 5) 77 1 -3344 



V contd) with no money. I knew no o 
is very dangerous in that area. Ver 
and returned to the institute, if I 

3)As a volunteer patient, 
drugs, but drugs were forced on me 

4)1 had no protection from 
violent tendencies. 

I will elaborate on the dr 
about it, but she said , '".Veil, we'll 
taper the drugs off." They did fina 
the first two weeks I received heav 
The first five days I slipped the H 
while later discarded them. But on 
ysis, and they discovered I wasn't 
threatened to give me the drugs by 
So I cooperated. 

The drugs were a depressan 
exaggerated by the depressing envir 
muscles tightening, poor coordinati 
of nervous energy that I couldn't r 
so that I couldn't relievi my thirs 
drugs in our food and beverages, fo 
lowed after each meal. 

I got out by the third wee 
eral months afterward from my treum 
combination of recuperating from th 
and an overwhelmingly depressing ex 

For about two weeks after 
of the drugs inhibited my ability t 
achieve an ejaculation or an erecti 
side effect, was that I wasn't awar 
I thought I was suffering some infe 
sex inhibiting nature of Mellaril a 
library research on my own. 

Many patients at the insti 
riuly from their doctor's "treatmen 
One patient, a young women, was rob 
she could do was stare at you when 
culty holding her hand when she tri 
four days for me to get a verbal re 
came very talkative, even smiley. 3 
ed a heavy dose of drugs ( I know b 
as withdrawn as when I first met he 
doses of drugs(about once a week) w 
out, allowed her buoyant self to co 



ne to go to there, and hitchhiking 
y good chances of being arrested 

attempted to. 
I requested treatment without 
anyway . 

the patients around me who had 

ug abuses. I spoke to my doctor 

see, and if you improve ,we ' 11 
lly, by the second week. But for 
y doses of Thorazine rnd Mellaril, 
ills under my iongue and a short 
the 6th day we all had an urin il- 
swallowing the medication. They 
injection if I didn't cooperate. 

t, which put me on a real bummer, 
onment, and the physical effects: 
on, clumsiness, exhausted and full 
elease, extreme dryness of mouth 
t, I believe they also included 
r the same dryness of mouth fol- 

Mearly June) and suffered sev- 
as at the institute. It. was a 
e orugs, the subtle cruel games, 
perience.. 

leaving the institute, the effects 
o function sexually. I couldn't 
on. The greatest abuse from this 
e that the drugs were responsible: 
ction or illness. I discovered the 
nd Thorazine after doing a little 

tute seemed to be suffering ter- 
ts" and the hospital environment, 
ot-like and so withdrawn, that all 
you said hello. She even had diffi- 
ed to brush her hair. It took about 
sponse from her, and then she be* . 
ut the next day she was administer- 
ecause she told me ), and she was 
r. It seems that she got periodic 
hich, when they started to wear 
me through. 

Eugene F. Catalano 



44 



RAPA 



NETWORK AGAINST PSYCHIATRIC ASSAULT 

629 Sutter Street, San Francisco, California 94102, (415) 771-3344 

VDLXCERPTb FRUM A KPFA PRfJ&HAM UN NAPA 

Wade: 1 worked for months in Marin county and I've talked with some 
staff at crisis clinics in 5.F. and I would say that one way or 
another, most of the people who come thru the doors of a psychiatric 
facility end up on drugs. 

Wanda:Yeah, you're drugged immediately on being put in a hospital 
without any recourse ... urn. . . well, you have no say so at all . I've 
been drugged... in particular, I was given at Napa State Hospital a 
drug called Prolixin which occasionally has a side effect of causing 
liver damage of yellow jaundice which I happenned to get from Proli<in. 
And I told them that I don't want the drug to start with, which they 
stapped me down and they grabbed me- a lot of the technicians will 
grab me- and give you a forced intramuscular shot of Prolixin, and 
once it's in your system, it stays in there for two weeks. And then 
it took me 3 days of forced drugging to convicc them and they read 
over my medical records that I shouldn't be taking this drug, that 
there was a real physical dancer to rue. 

Wade: Prolixin is the most evil poison on the drug market these days. 
It's the psychiatric prof ussion ' s answer to Methadone. I mean they 
even call it Prolixin Maintenance Program. It's because it's suspended 
in oil and so its time released and it works on your body for weeks 
afterwards, so you only have to come in once every week or once every 
two weeks. I too was given Prolixin against my will and wns told noth- 
ing at all about the side effects- none of my friends were told about 
hte side effects- so two weeks later I was just in Physical agony 
because of the side effects. My lips were swollen and I had uncontrol- 
lable twitches... just all kinds of things were happenning with my 
body that were driving me up the wall. 

Wanda:And the drugs can get ridiculous. When they g.ive me the Prolixin, 
I had also the side effects that Wade was mentioning. Well, they gave 
me Artane to counteract the Prolixin and they were giving>me 5inequan, 
which is kind of a tranquillizer, to make me calm down which over- 
calmed me, so rather than letting up on the medication, they then 
gave me Ritalin, which is to pep me up, and it was getting ridiculous, 
that I was getting so medicated that I had to take pills to get up 
and pills to go to bed, pills just to react and pills just to counter- 
act the reactions, and that was really getting ridiculous, but it's 
common. It happens to a large majority of the people. 



45 



NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 



VII ) I arrived at Napa state mental prison in August '74. I was 
emotionally disturbed. They threw me in a cell for three days cause I 
was frightened and would not speak or respond. 

When they let me out of the cell I was allowed to see my 
brother and sister and was assigned a social worker. He assured us all 
he was trying to help. Ha-ha. 

When my family left he presented me with two blank forms arid 
said he could not help me unless I signed. 5o I did. 

After that it was nothing but needles and pills. I did not know 
what to do. So I called my employer (a friend) and he came with another 
good friend. They were outraged with what they saw. I could not keep 
awake and kept falling off the chair. I was not told why but they were 
not allowed to see me anymore. 

Then my brother came again and they accused him of being drunk 
and on drugs. This was ridiculous. The power they have is frightening. 

After one month of this hell I was released to my sister. I 
immediately threw all the pills they gave me down the toilet. Three days 
later my whole body went rigidj I kept drooling at the mouth and my legs 
would not support me. The pain in my head was intense. We went to the 
crisis clinic at Mt. Zion where we found out this poison they had given 
me. Prolixin, had to be taken with the antidote, Cogentin. This drug, 
Prolixin, lasts in your system 6 weeks, but is administered in weekly 
doses. 

The 8 weeks it took to completely eliminate this drug from 
my system was the horror of my life. I had a continuous sickening feel- 
ing throughout my body. Each minute of this feeling wae an hour. The 
headaches were constant and I did not have the control to wash my own 
hair. My sight was blurred and I had no concentration, only intense 
irratation at anyone. My nerves-were like wire. I had no resistance 
to sheer terror. 

What did I do? Why me? How could they be allowed to-do this to 
me or anyone else? 

The way I see it, the State is burning people with Prolxin. 
Wonder how many people get struck without the antidote? 

When I was living through this I thought how merciful would 
death be. 

I feel sorry for those who are administering these drugs who 
have been made to believe they really are helping someone. 

Tracey Purcell 



83-303 O - 77 



46 

DAPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 

VIII) In February 1973 I was ;• first year psychiatric resident 
on ward y2 of 6.F. General Hospital. As I remember this case, a 
young man came in while I was covering ev nin;; call and I was res- 
ponsible for admitting people. I talked with him at ; rcat lun, th. 
He was very upset, and he was quite afraid, .nt times approaching 
panic. He sjemed to feel a bit better after our long talk. I sug- 
gested to him that he come into the hos"itnl for r few days and 
g.jt a re^t. At the time I wis still rather naive to think that any- 
one could get anything resembling a rest on ward 92. 'oil an.,way, 
he decided to come into the hospital and I admitted him. i)uring the 
talk I told him that I realized that he -/as afraid and that if he 
came into the hospital I wo ild give him Thorazine. However, T made 
it clear to him that it would be entirely his responsibility to csk 
the nurse for the Thorazine, and that he could only have 100 r\ . 
per hour. I told him that in my opinion this would h-ve a calming 
effect on him and would probably reduce his fear and panic. I ad- 
mitted him and wrote orders to the effect that medication would 

be given only if the patient asked for it. Of course I ordered Cog- 
entin to be given with it, if it was administered. 

I received an audit several days later. The message of the 
audit is that I would not be allowed to write orders that alio:; the 
patient to be responsible for getting medication at his own request, 
but rather that orders must be written such that the patient "Tl 'T 
receive Thorazine, several times a day, whether he wants it or not. 

Auditor: Sheldon Huf fman,H.D. Comment: Orug therapy was 
not appropriate for the condition diagnosed. Ft. diagnosed '/R and 
requiring hospitalization should be started on piienothiazines at 
once and not PRN. 

Jon Trefil, II. D. 

IX) I was institutionalized as a psychiatric inmate in Let- 
terman General Hospital during the summer of 197'. I vias coerced 
by the staff into taking gtolazine and other drugs against my free 
will. I was told by the staff if I didn't take the drugs, they would 
be .iven to me in liquid form anyway. Instead of going through a 
potential confrontation, I complied with their demands to take their 
drugs. 

The drjj&3_jjiadcijTio_^feeJ 1 _ctep2?^ 
myse lf and my ^surroundi ngs. Upon being released from LettormaTTT I 
threw away the supply ~ofStelazino they gave me at separation time. 
After I stopped taking the drug I started to be more alive, fcel_ 
more alert, and be more *waro of myself as a productive human being. 

Sheldon Arons 



47 



IMPA 



NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 

X) There are throe times i. was co,<imitted: '/oodsidc Receiving Hos- 
pital, Youngstown, Ohio from approximately l|/;!2/6y- 6/69, approximately, 
i shall refer to this as A in my discussion. Cook County General Hospi- 
tal, Psychiatric section, Chicago, Illinois from Novembor 29, 1971 -Dec- 
ember 10, 1 971 • This shall bo refered to as B in mv discussion, San I'atco 
Chopo Community Hospital, ,"an Ilateo, California from 10/1 1-or-l6/72-apo- 
roximately 11/19/72. This shall be referred to as C in my discussion. 
Drugs (riven : 

A. Thorazine, injections, four times daily for the first two 
months of commitment, about 1 ?00 m . total. Thorazine tablets, 2. c >'0 m. . 
size four times daily for the third month; three timer daily on an out- 
patient basis for the next three months. Miltowm three times daily by 
mouth for the first three months; dosage unknown; 100 m; . three times 
daily for the next two months. 

B. Liquid Mellaril three or four times drily and an unknown 
assortment of other "zombie-izing" drugs. 

C. Dilantin, three timos daily, 100 mgs. .'.telazine, l'our times 
daily, 2?0 mgs. Artane, one tablet daily to counter the side effects of 
the Stolazine. 

Side Effects: 

In A, I had good reason to believe that I was pregnant as 
evidenced by morning sickness and a suggestion by a doctor in the Bryan, 
Ohio hospital that I might be pregn.-nt because I had all the symptoms ^ 
and had not been using any form of birth control, plur had been on TH '- 
R0ID I-IXTRACT for an underactive thyroid through a doctor at the Kent 
State Univ. Health Service. The thorazine caused severe dryness in the 
mouth, few bowel movements and constipation, problems with breathin; 
throu h my noso and a desire not to breath at all. It was a real effort 
to breathe, f just wanted to quit broath'.ng and die. I remember the wish 
to die especially. Urination became painful and infrequent, leading to 
build-up of fluid in the body. This was uncomfortable. I suffered a Iocs 
of appetite, but ate under the threat of an isolation cell, (rsuplly, I 
had a good appetite.) Pood had no taste; it was like eating so much saw- 
dust. Ky breasts oocame enlarged and sore. I am deaf, [>0 > in the hearing 
ran L e; but I was horrified to hear that I could not hear at all under 
the 'thorazine nor could I see. I was denied the use of my hearing aids 




There must have been some damage to my - 

zy in cold air since and ,.et motion sick quite often. I never was motion 
sick before the committment, i was also left with a susceptibility to in- 
fections which I did not have prior. If I scratch myself, it now oe comes 
infectod with t> physician's care sometimes being necessary. 1 had revere 
anemia, even after I stopped taking the drug, 'or one year afterward, I 
was moody, severely depressed, physically worn out all tne time, ana un- 
ablo to perform any wifely duties, such as housework. Sex was something 
that did not interest me. I performed it only at the request of my husband. 
and was happy he did not want it much. I also had a tendency to narcolep- 
sy and also to muscular tenseness. I suffered sevoro back spasms that 
would make it impossible for me to walk f6r days at a time. 

■ I 



48 

TIAPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco, California 94114. (415) S63-4488 

X, cont'd) I also lost the child I thought I was cnrrying at aDout two 
months in the institution. There is no corroboration for this because 
when I expelled the fetus into the toilet, a nurse's aid or some sort 
of untrained attendent was with me and flushed it down. t;o pregnancy 
te3t was done because my husband refused to believe the Dr. in 'iryan, 
Ohio and did not even tell the psychiatrist at '/oodside that I thought 
I was pregnant. After tho spontaneous aoortion, I had one menstrual 
period and never menstrated again until six months after I threw the 
thorazine away in Aug. 69. 

One really peculiar side-effect was a severe paranoia auout 
going out into the daylight and outside of my home after I got out of 
A. I refused to go anywhere. I could not convince myself bt logic that 
I would not be hurt by some unknown . vil force, j. began to f i t ht again- 
st this feeling and finally decided that the only way to i et rid of it 
was to throw the medicine out. Six months after I turow the medicine out, 
I began to get out of the house. 

In B I was pregnant through a rape. I1y husband had arran ed the 
commital because he felt I was crazy because I had been raped. I did not 
want the medicine, but it was forced on me. I sat around in a stupor all 
day from it. 

In C, the side effects were similar to A, but not as severe. 
I did stop menstruating for a couple of months. I then developed an in- 
fection in the blood and anemia, which left me wide open to hepatitus, 
when I had recovered. 

In all three cases, the dru, ,s started a weight f,ain that was 
almost impossible for me to control until I got to the point where I 
had to do something drastic like stop eating. 

In all three cases, if I protested against the me.iicine, I 
was a difficult patient. I had no side effects: I just thought I did. 
I was insane, therefore no one believed me, not even that I war a college 
graduate, though I have my degree hanging, on my wall at home. I had ab- 
solutely no choice in what drugs I would take nor did I have the choice 
not to take them. 

In A, I was beaten severely and tied down to be injected if I 
put up a fuss. In B, I had no choice and was again oeaten by a black 
nurse. In C, I was threatened with permanent committment to NAPA if 1 
did not take the medicine. 

I feel that I was forced to take medicines that are systemic 
poisons which drive a person's lo ,ical thinking straight to hell. I re- 
sented tho tampering with my mind. At one time, I was a fine, promising 
young chemist. I have won scholarships and awards alore, but I cannot 
find a job in my field now because I have that mental institution record. 
I hope that these drugs are outlawed permanently. They are worse than 
taking arsenic or strychnine because they leave you alive in a dead body. 

Kathorine M. Oates Runkle 
Member, Amer. t.hem. ociety 



49 

nAPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street, San Francisco, California 94114. (415) 863-4488 

XI) I was a psychiatric inpatient at the Contra Costa County t;os- 
pital, J ward, liartinez, Ca. for 13 days- from 1 0/24/74-1 1/6/74. Ouring 
the first Wo or three days there I received no ppychiatic medicine 
because I had not yet had an interview with my assigned psychiatrist, 
Dr. Bentinch. 

During my interview with Dr. Bentinch I was told that she was 
going to place me on a drug called Norpramin, 'he told me that "we're 
not sure how it works" and that it was one of the newer drugs- something 
that mi ;.ht help ease -my depression and make me happier, ooon after my 
interview I started receiving my Norpramin at regular intervals through- 
out the day. Two little yellow pills were given to me four or five times 
daily, '".ecause medications were a big topic for discussion among the pat- 
ients on the ward and because I kept forgetting the name of it (the name 
was new to me ) I was forever asking the medication nurse what I was being 
given. Sometimes they wouldn't know; sometimes they knew but wouldn't 
say. 

After ahout seven days of takin, . Norpramin I be r.n to^ experi- 
ence what I can best describe as sn-all seizures* rimlrr to petit mal. 
Usually I would experience five or six of these upon first getting up 
in the morning. After a cup or two of coffee they would cease. About 
the tenth day, these seizures continued well into the day about 15 to 
45 mins. apart. Each day I would either spill a cup of coffee or drop 
a cigarette depending on what I was doing at the time. On the 1 1 fch day 
these seizures continued into the day and into the ni; ht. I nsked to see 
Dr. Kaynard, the staff physician, and told her that the drugs that they 
were giving me were causing some side effects. Dr. T'aynard said that she 
would consult with Dr. Bentinch about changing my moaication but she did 
not order it stopped or advise me to stop takin . it at that time. Also 
I mentioned to her that my hands were shnking and that they normally had 
a slight tendency to tremble but they were shaking kind of bad now. r 
attributed these side effects to the drug Norpramin. Two neurologists 
were consulted and I was given a test on a machine that measured the 
electical impulses of the nerves in my hand, recorded these impulses on 
a tape recorder, showed them on an oscilloscope, nnd could play them 
back later if need be. I told the medication nurse that i was no longer 
O oing to take Norpramin and that she could just ,,ive ome other drug. 
After some hassle she left and I didn't have to take it. >ch time I had 
to hassle with the nurse and explain that I had beeb having bad side_ 
offects, that I had seen the doctor and that I wasn't goin ( _ to take it 
anymore. For about two days they stopped giving Norpramin and put me on 
five mg. of Valium. Then they i,ave me one 25 rag. Norpramin and a Valium 
each time. I used to get two 25 mg. of the Norpramin each time. Things 
got better and after I got out of the hospital and stopped taking Nor- 
pramin, the tremors in my hands subsided and are now almost imperceptible. 
I attribute the side effects to a prolonged buildup of Norpramin in my 
body, namely: the 50 m s. four or five times a day for at least seven 
days. The bill from the hospital pharmacy lists 172 Norpramin 25 mg. 
pills that were given to me. Of this number 60 of them wore given to me 
to take home. This means that I was given 112 pills over a 9 or 10 da;; pd. 

Bob Nicholson 



50 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 

XII) I am writing this in angry response to my treatment two years 
a;„o as inpatient on ward III (third floor) at Langley Porter Neuropsy- 
chiatry Institute ( 3. F. ) . 

I willingly committed myself in Oct. of 72 because I felt at 
the time that I could not function normally in this society. The vehicle 
for this decision was my prior and occaisional (2 yrc.) use of mind- 
altering dru. ,s (LSD, Psyillosybin, Marijuana) and hence the stark rea- 
lization of my oppression in an uncompromising cruol societal environment. 

My abhorrence to this situation results in my telling you of 
my forced treatment to Prolixin shots (intramuscular injections of a 
phenothiazino similar to Chlorpromazine, or Thorazine), in ^ the beginning 
of November i was told that I would receive these shots twice a week, l 
agreed to this, Soon after t.ie first few injections I had a very common 
physical reaction to the drug. My mouth became locked and frozen in an 
open position in excruciating pain. I became extremely frightened, began 
screaming, for help and finally (when I was barely able to utter intelli- 
gably) asked for some Cogentin( a drmg which supposedly nullifies the 
side effects of phenothiazines-dry mouth, lock jaw, etc.). The psychia- 
trists told me my problem was psycholo u ical, which about drove mc to com- 
plete insanity. Finally, after a few days they gave me some Co.ontin 
along with my shots, and the problem in my mouth became slightly reli- 
eved. Soon after, I refused completely anymore injections. They summoned 
a very large man to"assist"me in complying to their requests, and 1 wil- 
lingly received my next shot. 

Being drugged for three months was a very painful experience 
for me. 1 felt as if I was a puppet on a string, slow moving, tired all 
the time, thirsty, "angry and frustrated, but not bein,. able to do a thing 
about it. All I wanted to do was lie in bed; I truly felt like a zombie. 
K.\ bones and muscles were stiff. I was told later by friends that I was 
hunched over like an old man. It took many months for the dreadful effects 
of "medication" to leave me when I was finally discharged. 

Daniel Eisenberg 

XIII) I was so heayily drugged that I had difficult in walking or 
talking. I am not sure of the dosage of the drug, but it w & s Stelazine 
and Cogentin three times a day. It had a terrifying result on a kid 
whose body weight was onl'j 95 lbs.. The more I'd complain about the drug 
... the more I was told that the way i was"acting" was because I wanted 
to be that way... it had nothing to do with the drug. I was finally con- 
vinced that i was a worthless selfish human being for acting this 'sick'' 
way. ..that for some reason 1 really wanted to be this way. I was disgus- 
ted that my body wouldn't do the things 1 was told to do... I was nick- 
named "zombie", l was told how gross i looked and to shut my mouth and 
quit drooling, i concentrated so hard on getting control of my body... 
it was impossible.. .and I was made to believe I was to blame. I couldn't 
take it that I deliberately wanted to be this way and hurt those that 
loved me... as well as myself. 

3eth 'uiros 

St. Mary's McAuley Institut 

Dec. 71 -Jan. 72 (S.F. ) 



51 

I1APA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street, San Francisco. California 94114. (415) 863-4488 

« J i V ] . I reali ze I have to write this and I think its imDortant. I 
feel it's an experience most people aren't aware of. oomctnin that I've 
Deen through and (l started to say Maintained the presence of mind to 
report to others. More accurately: that I believed there wore people 
in the world who would want to know, whom I could relate this experience, 
to is what maintained my presence of mind. In the ways people have avoid- 
ed this experience, it resembles the narrow one-sided attacliment of all 
forms of racism, sexism, or nationalism, it's the chauvinism that every 
person who has learned all their lives to adapt themselves to the society 
feels when they believe that anyone who does not function like they do 
or percieve reality in the same way as they do is insane or somehow 
less human. 

in specific, I've been asked to report on dru (j ed induced sei- 
zures brought on by drugs administered to me at NAPA State Hospital, 
Imola, Ca. , in the summer of 1973* Next to report anything the drugs 
given me there may have done to me. First, a purely subjective statement 
of my feelings: 1 felt that the drugs in whatever doses or quantities 
were the most fatalistic and despairin moments I've had on this planet. 
The only way 1 can describe that despair is that my consciousness was 
being beaten back by tranquillizing drugs, hypnotics, and other dru s • 
used in their programs of mesmirism or narcosis. They prevent „ou from 
carrying on thought processes. They hold you in a tight circle of tho- 
ghts that never find fulfillment, that never find freedom of expression. 
Totally hopeless, a feeling of hopelessness in my body that placed me 
placed me on my bed for most of the day kicking my le (j s. A hopelessness 
that I was never ^oing to be able to confront my problems, that 1 would 
never be able to surmount my problems, that I was never going to become 
potent, that I was never ij,oinj_, to become capable, that I would soend my 
life in the back wards of this mental hospital because the things I 
thought were unacceptable to my race and nation. It was terrible. 

As far as the worst experience i ever had, it was a drug ind- 
uced seizure brought on by large doses of Thorazine in orange juice. I 
began to realize that the anxiety was overwhelming me; that I was not 
physically or emotionally ^oing to he ablo to handle it; I was not in 
control of my thoughts, i was not in control of my being, I was not in 
control of my body; it beg.-in to kick and I couldn't stop it. i was laying 
in the ward and felt I wasn't (j oing to be able to ^et to the front desk 
where the technicians were in time to tell them that some thin., was ter- 
ribly wrong, that i wasn't goinr, to make it, that l was maybe about to 
die. When I got there all I could stammer was that there was something 
wrong. They don't believe anythin;, a patient tells them because they 
think you're crazy. I tried to convince them it war tuo drugs and not 
me. Then right in front of her I lost it, I couldn't stand, I went down 
on the floor, 1 went against a concrete post. The worst thing for me 
was that my neck was twisting to the right. My head was being turned that 
way. Like if you've ever experienced a muscle cramp you realize it's 
tightening even though you'ro trying to relax it. As my neck twisted, it 
would start to cramp from the strain, then it would snasm, loosen, and 
immediately cramp again pulling to the right. -"'y legs and arms were con- 
torted in that they slapped tho floor and shook with the spasms, I cou- 
ldn't control them and I knew that. I was going to % go out. that I could- 



52 

IMitt 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 

'.TV cont'd) n't handle it, that there was nothing else I could do about 
it or anything else, that l didn't know what was going to happen, that 
my system, my body, and my buin^ were so messed up that it was now des- 
troying itself, and the fear that I was dying. They returned to give mc 
a shot in the rear end and that was the end of it. I went limp all over 
and l thought that one of their "drug commands" aborting another one of 
their "drug commands" was the only real justice. 

Anihil Fani 

XV) On Sept. 29, 1973, I was taken to Napa State Hospital after 
having plead . uilty on a negotiated settlement. I was / ivon three ..ears 
probation and as the judge put it, " with the stipulation that l sign 
in as a voluntary patient at Mapa State Hospital". 

v.'hen I arrived at the hospital, I was interviewed by a psychia- 
trist. He said that he would put me on Stelazine, 10 m^s., twice a day. 
The only reason he could give me for putting me on the drug was that it 
would "help me". 

After having taken the drugs for a few days 1 noticed several 
symptoms. Amon;, them were: tiredness, double vision, muscle tremor and 
a' general feeling of not being able to , et my thoughts together. I told 
the doctor about these symptoms and he said that the feeling of not be- 
ing able to get my thoughts together was not from the drugs. As far as 
the other symptoms were concerned, he said that the good produced by 
the drugs far outweighed the side effects. 

I continued to protest to him and also to other doctors. They 
all said that i was better off with the medication and that it was the 
only way that I was going to get well. They refused to tako me off the 
drugs. 

As sson as I got out of the hospital in late January of 1V75» 
I immediately stopped taking the drugs they nave me. About a week later 
the symptoms I mentioned before gradually stopped. 

Hobert Vignone 

XVl) Psychoactive drugging must never be excluded from any_ com- 
prehensive forced treatment program and believe me, McAuley's did jus- 
tice to the drug companies of America. Adults were drugged into zombie- 
like states. Children were heavily drugged only on admission and during 

l'aula Pine, Ilurre 

.'t. Gary's I'cAuley institute 

Aug.72-'ept.73 (S.F.) 



53 



flAtt 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street, San Francisco. California 94114, (415) 863-4488 

XVIi) On Au ust 5, 196v, I voluntarily signed myself into ^oyberry 

S£vS^T hl *i r iS h °^ al in Iia ™P ton > Va. The outside sign read onlv 
Jayberry Hospital and there was no information in the admittance form 
co notiiy the .erson that it was a mental facility. I thought it was a 
regular convalescent type hospital. My problem was physical— a run down 
condition and normal transient situational r action— nervousness over a 
marital separation. I desired short-term conventional care: bed rest, a 
complete physical check-up, and professional guidance to help save the 
deteriorating marraige. It was my intention to seek marital counseling 
for Mr. Avare and myself later, on the outside. After a few days of lei- 
sure and conservative medication, 1 recovered from my fatigue and was 
ready to leave. Instead of releasin,, me upon request, the psychiatrist 
ur. .V.J. pile, who is the director and founder, unbeknown to me called 
my husband in Virginia Bench, Va., and told him not to pick me up, as 
scheduled; that i would require 00 days of inpatient care for a schizo- 
phrenic disorder. He hung up before my husband could question him-there 
was no disclosure of the facts. Dr. Pile proceeded to heavily drug me, 
wmch kept me from asseting myself and leaving over the weekend. Sarly 
Monday morning, the 13th day after arrival, while I was still sedated, 
the doctor subjected me to a first ECT and insulin coma. He never even 
met my family before. ; Jhen they found me in such a dazed amnesia state 
of mind they wanted to remove me, but were informed that "once the shock 
treatment began the patient must continue the full series or s/he would 
not recover' . "hey were never informed of the risky, experimental drugs 
given. They were afraid to take me home with such symptoms (EOT and tox- 
ic reaction) and without the doctors consent. My fainilv was ignorant of 
wnat was happening. There was no informed consent, no notice served as 
required by Vir inia statute, 196V, no committment process, no hearing. 
All my rights were violated. The medication I was forced to take inclu- 
ded: almost consistently 100mgs. Thorazine, 5 mgs. Valium, 2 mgs. Artane, 
and 1 mg. Haldol, per day. I was forced to submit to the entire, pre- 
arranged, blanket radical massive treatment program without any modifi- 
cation. The doctor ignored the svero side effects I developed. I suffer- 
ed nearly every complication known. Many were noted in the Nurses daily 
.3. '. chart: chronic acute skin infection, milk in broasts, hemorraging 
from the rectum, paralysis, numbness, cramps, memory impairment, diabet- 
ic symptoms. Off the record: I have been diagnosed as having reactive 
hypoglycemia and an early diabetic condition. We are convinced that the 
Insulin and drugs permanently damaged my pancreas. There is no diabetes 
on either side of tii .• family. 

The mind altering dru._,s and devices so altered m> natural met- 
tno'ilism and chemistry that I did not have a period for a year; T was 
always like clockwork before. There was also acute constipation which 
caused fissures and necessitated a rectal surgery, two years after dis- 
charge. I was so handicapped the first post hospital year, that I cried 
and grieved myself into a prolonged anxiety and depressive state. The 
twenty convulsive plus ten regular shock treatments left me like an a ed 
stroke or senile victim; I couldn't even cook-after fifteen years exper- 
ience- without a cookbook. The second year I was little improved, ."o fear 
iul and alarmed over the many after effects that I was like an insecure 



54 

nam 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 

XVII cont'd) neurotic. 'Vhen I entered Bayberry, I was a healthy happy 
35 yr. old woman; threo months later I was released broken in body and 
spirit. The tax- payers paid over 7,000 dollars, under Champus, for the 
unnecessary hospitalization and hazardous medical assault. The doctor's 
defense has been that I verbally agreed to eta.; for the anti-psychotic 
program. My record proves him a liar: Before I became too zombified, I 
strongly protested and rejected all treatment. My family has confirmed 
this truth along with the nurses and staff report. 

During the 10 day observation period, the record shows that I 
was cooperative, active, talkative, pleasant manner, adequate appearance, 
in good spirits, well oriented and quiet. There was no rated dynamic ac- 
tivity, medical criteria or abnormal behavior to warrant anything other 
than a minor tranquilizer for restlessness. 

The doctor has belatedly admitted, under pressure from my fam- 
ily, that the diagnosis of chronic schizophrenic undifferentiated was '. 
incorrect, and to cover up for the unjustified, indiscriminate, wasted 
psychiatric "care"- he changed the label, in two post letters, to either 
manic depression or disassociatve reaction. Dr. Pile did create a simu- 
lated psychosis of poor judgement, slurring of speech, inappropriate 
mood, extreme confusion, disorientation, etc., with tho drugs and shock 
treatment. I will point out that during the tree month inpatient period 
not one anti-depression drug was prescribed, and if I was not schizo- 
phrenic, then the 52 Insulin comas were ill-advised. 1 will conclude with 
that after such psychiatric quackery and butchery, 1 was lucky to main- 
tain my "mental" health. However, the drug and shock treatments did ruin 
my overall health and caused me to have a physical nervous breakdown for 
which I received conservative, conventional medical care. 

Vivienne Avare 

XVIIl) I first encountered phenothiazine and chloropromazine dru tJ s 
at Stockton .itate Hospital during the years 1972 and 1973. I had come to 
Stockton in a state of collapse and so called "schizophrenia" because I 
knew my sister's husband was a psychologist affiliated there. 1 knew 
therefore I would have some degree of protection. 

I was given the drugs and was allowed to be an outpatient 
living under the care of my sister and her husband. hat I needed was a 
place of refuge, and Stockton was not that, for I was told I was to be 
given shock treatments. My brother-in -law interjected and I was given 
tho drugs by another doctor there named Pat v /hite. 

The first dru k> I was given was Tindal. Then over a period of 
a year and a half I was riven a combination of drugs including Prolixin, 
Mellaril, glavil, Hitalin, and always accompanying it was Artane, tho 
so called anti- parkinsonian drug that counteracts the dangerous side- 
effects of these phenothiazines. Also included alone with everything 
was the infamous Valium, which is not a phenothiazine. 

It should be mentioned that I have had tho parkinsonian reac- 
tion three times in my life-severely. The first was when I was twenty 
and tried to kill myself with my sister's Stelazine. I '/as told I'd be 
allergic to Stelazine always. 1 did not know. that it also meant all the 



55 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street, San Francisco. California 94114. (415) 863-4488 

XVIII cont'd) "zines" as l call them. I have had the parkinsonian re.'«c- 
ti'ii from simple Compazine, which was given to me for surgery once to 
counteract nausea. The parkinsonian reaction of locked jaw and head 
jerking to the side and spasms is anything but fun. I had it a third 
time after Stockton when 1 took 5 Navano to sleep, not knowin w that 
Navane was a phenothiazine. 

At Stockton I was an outpatient and saw Pat Whyte once a week. 
I first began to note my arm stiffness when I had difficulty playing my 
guitar. Before I came to Stockton, I had made my living singing and 
p'aying guitar, When I told Pat Whyte of the hand and arm stiffness, and 
how I could not play the guitar and thought it was related to the drugs, 
she said 1 must be getting arthritis. Yet I noted it was connected with 
Elavil, in particular, when it was added to the other drugs. I had to do 
strums as opposed to the picking techniques I used to use. I also could 
not do arpeggios while on the drugs. 

After about a year, I went to the department of rohabilatation 
to be tested for work and i flunked "manual dexterity", and I, used to be 
a guitarist. 

After I left Stockton and got off the drugs, my doctor at Glad- 
man Psychiatric Clinic was giving me Mellaril to sleep. 1 had not rela- 
ted the arm-nand stiffness with this small amount of Mellaril. However, 
I did keep a behavior modification chart in an attempt to gage causes 
and effects. The arm stiffness then was not in the joints; neither was 
the hand stiffness. It is now. I have had one doctor, a Dr. Roberts of 
Alta Sates Hospital, who said that yes, the phenothiazines can make an 
arthritic condition worse and that it can even precipatate such a con- 
dition. Dr. 3111 Sullivan of Gladman Clinic, whom I saw for a year, has 
said, "ves, 1 0',J of those people taking phenothiazines suffer from the 
arm and hand stiffness if they take them for over a year. 

The fact remains that I attempted s icide with the Stelazine, 
and in that sense it was my fault, at age twenty, ilut these drugs should 
not be given or allowed to be around> period. They are dan;;erous. 

Joy Andrews 

XxX) When I was hospitalized, I was i;iven tranquillizers, which as 

the name implies are supposed to make a person tranquil. The results were 
just the opposite. I developed akathasia, which means one can not sit 
still or relax, but instead one feels compelled to bo moving around and 
pacing the floor. The "tranquilizers" also made me feel depressed and 
interfered with my memory and ability to reason. 

They also made me (j ain a lot of weight in a very short time. 
I also had insomnia because of the akathasia and the muscle cramps. The 
muscle cramps caused by the tranuuillizers were very painful and thou.h 
I was also on a drug called Artane which is supposed to counteract the 
muscle cramps and akathasia, I still had the side effects anyway. 

All in all my experience when I was on"modication was one of 
the most horrible experiences of my life, and I felt better before I 
went to the hospital, than while I was there receiving "treatment . 

3ov rly Schwab 

San iJie,_,o County Univ. 
iiosp. (0ct-iJec6ti -:Apr- 

•V; r ' 



56 

flAffl 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 

XX) l experienced many drugs during my youthful exp rimentation 
days and I'd like to relate to you some of my experiences and thoughts 
on the often forced psychiatric chemotherapy drug called Artane. I have 
never been under chemotherapy nor have I ever taken such psychiatric 
drugs such as Thorazine or otelazine, etc, 3ut during my freelance drug 
experimentations, I had the unpleasant experience of Artane. 

Naturally, I've had some lousy drug trips anion, some of those 
I took. I had bad side effects from all of the hard drugs sooner or lat- 
er and I had a feu unpleasant LSD trips but at least) L-JD always let me 
down with a "parachute feeling- The worst trip I ever had was when a 
speed freak super overdosed me so he could take my car to out of town 
parts to peddle his speed while I was helplessly having a super nervous 
breakdown and couldn't even pick up a phone for 3^ hours, because every- 
thing I looked at grew to mammoth proportions and seemed to chase me 
around the room, threatening my life ominously and totally. 

Yet even now I could understand how the speed could have done 
that to me and how the other hard drugs had their various bad effects; 
but what I experienced on Artane is not something I can understand, and 
if it does to psychiatric inmates what it did to me- it is really a 
terrible thin^ for them to be u iven it. It was the s econd most horrible 
dru experience that I can recall, for the following reasons: Five lousy 
little mgs. entered my body on a day when I had taken no other drugs in- 
to my system for at least 2l\. hrs. The person who gave it to me told me 
it was used on people with cerebral palsy.. He left to O o somewhere or 
other and no one else was around. I was sitting on my oed and as soon 
as I started feeling the Artane I realized I couldn't shift position- 
I was stuck to the spot-my nerves astrally projected themselves on to 
the walls and turned into writhing slimy lizards and such and kept dar- 
ting threateningly towards me, through me, and back on to the wall. I 
was shaking and felt paralyzed at the same time. This seci.ied to go on 
for hours- it became terribly tedious, repetitive and monotonous until 
I thought I was really helpless and this was the end of me. Then with 
no feeling of warning that the scene was about to change, all of a sud- 
den all the lizards were gone and there was a red "hot rod" convertible 
projected on the wall. In it were two figures- and somehow I felt they 
were my unidentifiable two best friends from my entire life- one of them 
was laughing and talking and driving the car on the wall and then across 
the ceiling to a huge round dark hole. The hole there was real. I knew 
bocausc I'd foen it often enough, '.fliat it was was an excavated area 
where a light fixture had once resided and from it hung some grotesque, 
black taped wires. However, during the Artane experience the little red 
convertible and people in it were as real as the hole and the wires on 
the ceiling, and they were driving towards and into the wires and I was 
sure they v/ere going to die of electrocution and that they had to be 
warned. I started actually screaming to thorn that the., must stop and that 
they couldn't drive through it and would be killed- and I felt myself 
d^in^ as their front wheels entered the ceilin hole and I know tnat 
somehow because of the dru^, they couldn't hear me, but yet I way attach- 
ed to them. 



57 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco, California 94114. (415) 863-4486 

XX cont'd) My screams brought the buy who had iven me the Artane and he 
started slapping me to break mj hysteria and then I simply blacked out. 
Later I asked him how Ion;; I'd been on the Artane and he said he'd only 
been out of the mom Tor 1f> to 2'> mins. -yet I was sure it had been 
four or five hours. The Artane was so"bad scene" that I just finally 
exhausted my brain on 't and blacked out. (The gu;,< didn't slap mc that 
hard. ) 

Cheri Czain 

'■Jd.Note- Artane and Co gentin are in the same class of chemicals as 
belladonna, . :copalamine (see article on "oleep rills Under ?ire"), and 
Atropine, which are hallucinogens. The Physician's Desk itefcrence notes 
that Artane, for example, can precipitate a toxic psychosis, "'he editor 
knows of at least two other people who have had similar difficulties. 
One was definitely under medical rup ^rvision on a ward at the time, and 
the Artane was given to counter phenothiazine induced side effects, he 
did not hallucinate as vividly as above, but did report feeling "spaced 
out" and disoriented. 

XXI) One patient has been on the ward for nearlj one year, and has 
been wrapped up in sheet restraints many times for screaming, spitting, 
hitting, etc. One period, the doctor ordered a special sheet program 
(Aug.7U) in which he was to be in sheets for two hours out of every 
three. He was on this schedule for about five days and spent between 
10 and 17 hours a day in sheets in this program. 

After these five days of the sheet program, the patient was 
submitted to the ultimate in physical and mental control-!. nown as sleep 
therapy, a treatment in which the patient is kept in a dru u induced state 
of hcav,,' sleep, and woken at least every t\io hours for sleep medications 
and other psychotropic drugs. The patient mentioned previously was put 
on sleep therapy immediately following, those five days of sheeting. The 
doctors orders on this program involved l|.00-< c 00 m, s . of Thorazine orally 
every other four hours, three times a day. The normal dosage is UOO-oOO 
mgs. a day all day long. In addition, there were generous dosages of 
Librium, Mellaril, Stelazine, Sodium Amytal, Haldol, Co^entin, and Colace, 
the last three administered as "bedtime" dosages. As is common with al- 
most everyone on sleep therapy, he developed a high fever, lost -weight, 
had heavy che.:t conjestion, and was given medications and other treatment 
to counter developin pneumonia. The patient iu supposed to o; out of bed 
at least one time each shift, but since s/he is usually too weak to move 
even an arm, or open there e. es, they are carried, feet dra.„. ing en the 
floor, around the room or hallway, and then returned to bed. 

This partic ;lar patient was on sleep thcrap . for 10 da, s . Tie 
had a fe- "quiet days, accordin to the staff, and then appeared to re- 
main uncooperative. After bein sheeted many times during the next two 
weeks, he was put back on sleep therapy for another J> days, because he 
seemed to have a few good days after the last sleep therapy. 

David Paul, - taff persor 
3t. Mary's McAuley Ins tit. 



58 

nAPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

2150 Market Street. San Francisco. California 94114. (415) 863-4488 

XXII) This is a statement concerning mj treatment from :;ept.-Nov. 
197U. I spent three months on a locked ward, anit 5 North, at St. Kary's 
McAuley Institute. i)urin c that time, I was goin through many self-real - 
izations which my halfway house felt unable to handle. I was taken to 
5 North where I was told I was sick, and did I realize my need for help 
from them? I said ,,es, whereas the doctor, backed by three other staff 
members, said, "That's why we're here, and if you trost us we can take 
care of you." So for three months I was locked down on 5 North. 

Of all the patients rights (there arc 11 of them in the law), 
I was informed only of my right to leave whenever I wanted. On the day 
after my admission, however, when I asked to sign out, I was told that 
they could keep me for three days to observe me. Three days later, I 
a ain asked to be released, and :as told to see my doctor. He told mc 
they could keep me for fourteen days. As I had voluntarily signed my- 
self in, understanding that at any time I could sign m,, self out, T ucman- 
ded to be released. His reaction was that he wouldn't provide t:ic neces- 
sary authorization needed. I was not informed of my ri^ht to a fair 
hearing as provided by law. 

I was given 60 mgs. of Stelazine and Co ,entin ever;, night- 
Stelazine for"paranoid schizophrenia" and Cogentin for the side .'ffects 
from the otolazine. I experienced .just a fjw side effects, being such 
things as drooliny, alternate tiredness and restlessness, dry heaves, 
muscular spasms, and impairment of vision. I experienced these adverse 
reactions, in spite of the Cogentin. 

Once I was ,yiven such a large overdose of Thorazine hat I . 
couldn't ,_,et up off the coach for ten minutes, 'hen the staff finally 
responded to my cries, I asked why they had given mc so much, and I 
was told they were just testing rr< reaction. 

The next day I was sitting in the day room when my left arm 
grew stiff and started to raise and extend. No matter how hard T tried, 
I couldn't lower it. Accompanied by a nervous churnin (j stomach, nr, arm 
felt like it was being pulled o-it of its socket by the fingertips, .joon 
my whole body was uncontrollably contorting. I could only whine for 
help, Jhile in plain view of the nursing station, I suffered; the staff 
took its own timo to help me. 

When help came, I was confronted as to what was wrong, and 
when with much effort I forced myself to say that I didn't know, I was 
told to stop actin u out, and that if I didn't c ntrol myself and behave 
in an appropriate manner, that I would have to go in sheets. At the time, 
I was having difficulty in breathing, so into sheets I went. "After all," 
one staff memoer said, "this isn't the kind of place you can act crazy, 
you know." 

Joseph ..aton 



59 



[Exhibit No. 4] 



IUPA 

NETWORK AGAINST PSYCHIATRIC ASSAULT 

629 Suiter Street. San Francisco, California 94102. (415) 771-3344 

NUMMARY UF THL AGNEv'S PHQJlCT . Rappaport. Silverman . et al 

In this study of young male schizophrenic patients who 
reported they were not taking medication at follow up, those treated 
with placeboes in contrast to those treated with chlorpromazine 
(thorazine) while hospitalized showed significantly greater long 
term clinical improvement, less pathology at follow up, fewer ^hos- 
pitalizations and better overall functioning in the community between 
one and three years zfter discharge. These individuals, in guneral, 
*ero experiencing an acute psychotic break and their first or second 
hospitalization upon-.edmiseion to the study. Between hospital admis-. 
sion and discharge those on chlorpromazine showed greater improve- 
ment. A greater proportion of those assigned to chlorpromazine while 
hospitalized, however, showed deterioration after discharge. The 
study supports previous observations that there is a subgroup of 
schizophrenics who do well or better long term without the routine 
or continuous use of anti psychotic medication. This finding underlines 
the need for more selective utilazation of antipsychotic medication. 



Number of patients 



Medication specifics Total Patients rehospitalized Percent 



Placebo 

in 

hospital 



Off drugs 
at 

follow up 



24 



On drugs 
at 
follow up 



17 



B c ,o 



Thorazine Off drugs 

at 
in follow up 



17 



Un drugs 
hospital at 
follow up 



22 



4 7 c ,» 



16 



73£ 



Cited: Schizophrenics For Whom Phenothiazines May Be Contraindicated 
Op Unnecessary; Langley Porter Neuropsychiatric Institute; 

Mail : Re search Department 

Agnevs State Hospital 
San Jose, Ca. 951 1 1 * 



60 



"The great virtue of the tranquilizers seems to be that they make the 
patient a more appealing person to all those who must work with him. 10 

"The most noticeable effect of the drugs is to reduce the hospital ward 
noise level. Bedlam has been laid to rest. The debate still continues as to 
what precisely the drugs accomplish, physiologically and socially. Some have 
predicted they would empty mental hospitals, and others have dubbed them chem- 
cial strait jackets. In the surprising, pleasant effects they produce on 
patient-staff relationships, the drugs might be described as moral treatment 
in pill form, as may be judged from the remarks of Robert H. Felix (1960) , 
Director of the National Institute of Mental Health: 

'"In the whole of materia medica, I suspect that the tranquilizers are 
the only substances whose responses have been measured or observed not only on 
the persons who recieve the drugs but also on those who live and work in the 
same surroundings. We have known for some time that if mental hospital patients 
can be made aware of the staff's sympathetic perception and high expectations, 
the patients will tend to fit the roles which are set for them...'H 

"...Above all, we have good evidence that the tranquilizing drugs make 
mental hospital patients easier to work with and live with. We cannot say that 
the therapeutic task is simple or easy, and yet therapists or therapeutic teams 
who are unafraid, and who refuse to be overwhelmed by the patients' rejection 
of them, are having successes every day in the treatment of these 'impossible 
people . ' " 12 

The drugs alleviate fear among the staff members. One researcher des- 
cribed an occurrence during his work; 

"On one ward, the rumor leaked out that the new 'medicine' was placebo 
and that the patients would in fact be taken off all tranquilizing medication. 
This almost resulted in open rebellion among the ward personnel, in spite of 
the fact that the original selection of patients was done with their full assis- 
tance. On the other ward, where there was no leak, there were no dif ficulties- 
we had no more difficulites throughout the remainder of the study." 

He concluded: "But the panic among some of the ward personnel shortly 
before discontinuation of the drugs suggests that the use of tranquilizing 
medication is motivated not solely by patient needs, but also by the fears of 
the treating personnel. . . ."" 

In discussing one major drug study the Joint Commission on Mental Illness 
and Health comments: 

"...However, since the physicians did not stick to chlorpromazine and 
reserpine but tended to try newer products in the tranquilizer group, the auth- 
ors interpreted the choice of which drug as to be of no decisive importance. 
This leaves room for interpreting the drug benefits as partly psychological; 
that is, as patients quiet down and become less disturbing, staff morale goes 
up and relations with patients improve." 15 

Perhaps one of the major uses of the tranquilizing drugs in mental hos- 
pitals is to quell the sexual ardor which perforce arises when men and women 
are artifically separated and confined in large cages with 60 or 70 other con- 
sons of the same sex. Female staff members on male wards are especially con- 
cerned with this problem. The drugs serve a major, but not often discussed, 

1 4 



61 



function in respect to controlling sexual drive while under confinement. 

"Inhibition of ejaculation occurs with phenothiazines , most commonly with 
thioridazine. It may be delayed or completely blocked. .. "16 

"Investigations in 81 patients - in whom the administration of neurolep- 
tics and antiparkinson agents, which had been administered for months or years, 
was abruptly discontinued - showed that such withdrawal can produce an abstinence 
syndrome comprising a feeling of warmth or cold, sweating, vertigo, tachycardia, 
a tendency to collapse, headache, insomnia, nausea, or vomiting. Tremor and 
the mouth- tongue-throat syndrome, exacerbated or occurring . for the first time, 
were also observed. I 7 

"An understanding of this type of drug dependence is important in order 
that the effects of sudden withdrawals of these drugs be known and distingushed 
from the symptoms of recurrence of the basic diseases. "18 

Besides the controlling sexual ardor the drugs have other devastating 
effects. "...these drugs have their side effects. The most well-known is 
parkinsonism and it is easily dealt with. A less obvious one is akathisia, 
a form of odd restlessness which is easily recognized once it has been seen. 
There are many minor side effects which anyone who used the drugs knows about 
or has to answer questions about: the possibility of epilepsy and headaches, 
dizziness and drowsiness, weakness and hypotonia, occasional development of 
raised temperatures, rashes and photosensitivity. Side effects which are 
worrying, but which fortunately are rare, are toxic effects on the liver and 
agranulocytosis. A minor one which is very alarming is oropharyngeal spasm. 
The patient will be brought hurriedly into the Casualty Department, w itk his 
tongue sticking out, unable to say a word and barely able to breathe." 

Many "patients" are left on high dosages of tranquilizers for years. 
The longer the tranquilizers are taken the higher the chance of permanent side 
effects. . . . 

Notes: 

1. Joint Commission on Mental Illness and Health, Action for Mental 
Health , p. 84 

2. Ibid., p. 59 

3. Ibid., p. 58 

4. Ibid. , p. 46 

5. "Preliminary findings from the Psychiatric Inventory" prepared by 
SEH staff. 

6. Joint Commission on Mental Illness and Health, Action for Mental 
Health , p. 47 

7. Ibid. , p. 40 

8. George W. Albee , from speech delivered at Case Western Reserve 
University, "Tear Down the Walls of Hell I" p. 5 

9. August B. Hollingshead, Ph.D. and Frederick C. Redlich, M.D. , Social 
Class and Mental Illness: A Community Study (New York, New York, John 
Wiley) , 1958, p. 275. 

10. Joint Commission on Mental Illness and Health, Action for Mental 
Health, p. 53. 

11. Ibid., p. 39 

12. Ibid., p. 87 

. 
IS 



83-303 0-77 



62 



[Exhibit No. 5] 

(Excerpt from) 

TOWARDS AN ENLIGHTOTED COMMITMEUT LAW* 

♦Based on a study of psychiatric institutions, especially St. 
Elizabeth's Hospital, Washington, D.C. 



4. The use of drugs in treatment 

Perhaps one of the most misunderstood phenomena is the use of tranquil- 
izing drugs in "mental hospitals". This is the Hospital's and the psychiatrist's 
closest link with real medicine. The drug is what gives life to the medical 
model and behavior and thinking. Only an M.D. can prescribe drugs. Only the 
M.D. claims to understand the drugs. But the fact is that there is only the 
smallest theoretical inkling of how these drugs bring about their effects. 

Though the claim is made that the drugs are for the "patient's" benefit 
in treating his "illness", none of the patients interviewed during the study 
said they felt any better because of the drugs and all reported feeling worse. 
As one doctor put it, "What we offer the patient here is control and the drugs 
are just another form of control - a chemical strait jacket." The most common 
reason given by patients for taking the drugs was to keep the doctor happy. The 
fact is that each "patient" is made quickly to understand, that if he does not 
take the drugs he is subject to forced injections. 

These drugs have devastating side effects and patients reported being 
extremely uncomfortable. Most psychiatrists interviewed admitted that one of 
their main problems was convincing a "patient" to take the drugs, and that once 
he left the "hospital" he usually ceased taking the drugs. These doctors ex- 
plained the use of drugs in the following terms "It's what a "patient" expects 
the doctor to do - prescribe drugs." In discussing tranquilizers the Joint 
Commission on Mental Illness and Health says: 

In short, we have new hope, Medicine long has believed that the man who 

12 



63 



feels he can do something for a patient and can impart the feeling to the patient 
that something is being done for him, may "pull" a patient through conditions 
that would overwhelm the bored, uncnthusiastic, or uncertain person. In less 
scientific circles, this kind of mutual enthusiasm is known as faith healing. 7 

"It helps cement the relationship of dependence between the doctor and 
the 'patient'." That is, the drugs are used largely as a means of convincing 
the "patient" that he is "sick" and because he is sick he must do as the doctor 
orders. The "sickness" model is used as a subtle form of control and manage- 
ment of human beings. It is never quite explained to the person what will hap- 
pen to him if he doesn't take the medication other than that he will be "sick 
again and have to remain in the hospital." He is never given the opportunity to 
weigh the supposed benefits of the drug against the discomfort of considerable 
side-effects. The benefit of the drug is artifically imposed. The drug will 
help him behave himself and hence the benefit is the avoidance of being returned 
to the "hospital" where he will be brought if he behaves badly without the drugs. 
The person often does not regard himself as being "sick" and is quite content 
having what others regard as an "illness" except for his social rejection and 
•the indignation of treatment and the discomfort of drugs he receives in the men- 
tal hospital. 

"Often, in these scientific days, chemical restraints have replaced phy- 
sical restraints. While it is no longer common to use strait jackets (although 
it is a rare state hospital that cannot produce them on short notice) , chemicals 
now produce a more general sort of restraint. Massive doses of tranquilizing 
drugs turn 'patients' into zombies ...all feeling blunted, all passion decreased 
all humanity smothered. The tranquilizing drugs do not cure. They blunt and 
they dampen. "8 

That drugs are given largely on the basis of social class has been un- 
equivocally demonstrated. 

"...How patients are treated also is linked to class position. Individ- 
ual psychotherapy is a major treatment in all classes, but the lower the class- 
the greater the tendency to administer an organic therapy, shock treatment, 
lobotomy, or treatment with drugs." 

Often it is the drugs themselves which are responsible for "crazy" be- 
havior. Tranquilizers often give people a blank starey look and make them slow 
in responding to questions. Sometimes they may give rise to even more bizarre 
behavior. For instance, one emergency application filled out by a doctor stated: 
"Patient is confused, incoherent, posturing, makes pill-rolling movements with 
fingers. How much of her behavior is functional and how much is toxic, no one 
can ascertain, as she has been taking medication largel y unsupervised. Medicat- 
ion should be adjusted under controlled conditions." 

One doctor as SEH reported discovering a woman who had been locked in 
seclusion for two years. As she became more and more disturbed they continued 
to give her more and more drugs. This doctor measured the amount of tranquil- 
izer in her blood and found that She had been receiving toxic amounts of the 
drug. His only treatment was to take her off the drug, and she immediately 
recovered. 

The drugs are used to make the hospital staff feel better and safer, by 
making the "patient" more manageable. 

1 3 



64 



[Exhibit No. 6] 



A Slavish 
Reliance on Drugs 

ARE WE 

PUSHERS FOR 

OUR OWN 

CHILDREN? 



We are a nation of pill poppers 
and potion pushers Most ol us 
believe in better living through 
chemistry, and we prove it by ingesting 
billions ol dollars worth ot prescription 
and over-the-counter remedies to pep 
us up. calm us down or keep us on an 
even keel It is hardly surprising, then, 
that many Americans reach lor drugs lo 
dose their overactive children 

Using drugs to control kids is not new 
In the late 1 800s harried parents led their 
unruly ollsprmg Wmslow s Soothing 
Syrup, an opium-based elixir available 
without a prescription Today, we manage 
hyperactive children primarily witham- 
phelamines and other prescription drugs 

Amphetamines, known popularly as 
"speed.' are what college students and 
truck drivers take (illegally) when they 
want to stay up all night, and what tat 
people take when they want to curb their 
appetites Though they are stimulants. 
amphetamines and similar drugs sup- 
press the symptoms ot hyperactivity in 
some children, possibly by enabling the 
child to better locus his attention and 
channel his energies 

For the past tew years, the medical pro- 
fession has been positively euphoric 
about the use ot stimulants lo manage 
restless children In a pilot study ol hy- 
peractive children, their parents and 
physicians who treat the disorder. 
Berkeley researcher Nadine M Lambert 
and her colleagues lound that 17 ol the 
48 doctors surveyed tell depriving a hy- 
peractive child ol stimulants was akin lo 
depriving a diabetic ol insulin Only 10 
disagreed and 21 gave no opinion 

Teachers and school otticials also 
seem hooked There have been stones ol 
teachers putting pressure on parents lo 
drug their supposedly hyperactive chil- 
dren, even when the child has not under- 
gone a complete meoical examination 



One California teacher recommended 
drug therapy tor nine ol her 28 students 
because she attributed their animated 
behavior lo brain damage And in a 
Rhode Island community, a doctor told 
the mother of a second-grader that her 
child did not need drugs, but she ought to 
give them to him anyway, "to please the 
school " 

In 1971 a panel ol experts met under 
the auspices ot the Department ol Health. 
Education and Welfare to discuss the role 
of stimulant medication in the treatment 
ol hyperactivity The resulting report was 
generally favorable toward careful use 
ot the drugs The panel concluded that 
although stimulants did not cure the 
disorder, they could make a child more 
accessible to educational and counseling 
programs Assuming that a child took the 
proper dosage, questions bl toxicity were 
"simply no! a critical issue " The report 
did not discuss specific cases ol abuse 
and indiscriminate dispensing that had 
received publicity in the press 

Perhaps because of the Government's 
positive stance, the stimulants have con- 
tinued to increase in popularity Nation- 
ally between 500 000 and two million 
school children take various drugs lor 
hyperactivity, though no one knows the 
exact figure Ritalin, an amphetamine-like 
drug manufactured by the Ciba Pharma- 
ceutical Company, accounts lor over half 
the prescriptions Dexedrme. an am- 
phetamine produced by Smith. Kline and 
French Laboratories, is next, accounting 
for aboul eight percent ol all pre- 
scriptions wrillen 

II each parent ot a hyperactive child 
spent only 20 or 25 dollars on medica 
lion, the prolits Irom drug sales would be 
considerable Some parents spend much 
more since their children take the drugs 
throughout childhood 

The drug companies insist on the 



safety ot stimulants lor children though 
there is little information available on 
long teriusidt:eflerls Rut there are re- 
ports ot suppression of normal growth, ir- 
ritability depression, nausea, pallor and 
insomnia 

Critics are also worried about the pos- 
sibility ot drug dependence Dependence 
is widely recognized as a problem in 
adults who take amphetamines lor weight 
control In 1972 the Food and Drug Ad- 
ministration declared that amphetamines 
have limited uselulness in treating obe- 
sity, and "because ot (heir significant po- 
tential for dependence and abuse should 
be used with extreme care " The foa now 
requires a warning label that cautions 
physicians to prescribe the drugs spar- 
ingly—tor obesity There is no similar 
warning required concerning their use 
by hyperactive children 

Some legislators have expressed con- 
cern about the incidence and treatment 
of hyperactivity Last July. California 
State Senator Albert Rodda chaired a 
one-day lact-findmg hearing Any legis- 
lation that results will probably call tor 
more thorough medical study ot hyper- 
activity and the effects of medication 

But there is surprisingly little public 
clamor on the issue even though every- 
one seems to have a hyperactive child, 
thmk he has one. or know someone who 
does As a society, we are ready to put 
people m |ail tor smoking a single man- 
luana |Oint but we seem strangely unin- 
terested m setting limits on legal speed 

The reasons are pretty clear We be 
lieve in drugs, if they can be viewed as 
medicine The Lambert study lound that 
parents ol hyperactive children were very 
likely to be drug takers themselves. 60 
percent look tranquilizers and more 
than 30 percent had taken medication 
lor weight control 

Undoubtedly the slavish reliance on 
chemical solutions is due to a general im- 
patience wilh complex situations, and a 
need lor easy push button answers 
Sometimes technology can provide such 
answers Often it cannot 

A Vermont psychiatrist was recently 
quoted as saying thai drug treatment of 
school children would be worthwhile 
even it the drugs tailed lo benefit the chil- 
dren themselves but only resulted in re- 
duced classroom tension and benefits to 
tamily members That is an extreme alti- 
tude, but one that others may uncon- 
sciously hold It is an attitude that could 
easily lead us lo become pushers tor our 
own children 

-Carole Wade Olfir 



M'CXXOOt 'CO*r DkwiW I9'l 



49 



65 



[Exhibit No. 7] 



THE CURIi 101 



[Drug Environment 'Drugged 
Environment] 

In psychiatry as in politics (or in politics as in 
psychiatry — it works both ways), issues of 
who's in control of whom, and how that con- 
trol is maintained arc of life-threatening 
importance, since control often means op- 
pression, authoritarianism, dictatorship (no 
matter what the politics may be called), and 
the absence of personal freedom. Outcries arc 
heard today about psychosurgery, electro- 
shock, lobotomy. and Ancctinc.' I'm glad to 
hear these outcries because I think it is neces- 
sary that people be warned about these brutal 
and dangerous methods of psychiatric/polit- 
ical control. However, the most widespread 
and frequently used psychiatric mind-control 
tools arc the psychiatric drugs. 

The number of people subjected to the 
torture and brutality of psychosurgery and 
Ancctinc is in the thousands and is increas- 
ing. 2 The number of people who arc being 
"shocked" is in the tens of thousands. But the 
number of people who get/take psychiatric 
drugs is in the millions and is growing at a 
phenomenal rate ( as are the profits of the 
drug companies — to be discussed later). To 
me, the way in which these drugs are used to 
control people often constitutes an act of 
violence by the doctors, nurses, psychiatric 
technicians and others who push these pills, 
although the violence in this case is often 
more subtle than that of napalm, bombing, 
burglary or imprisonment. 

The goal in prescribing psychatric drugs 
is to create a person with no ups or downs, a 
person balanced in the neutral, calm, col- 
lected middle-American mold. The premium 
of psychiatric drugs is their anti-intensity 
effect, the ultra-indifference they produce. I 
feel fine about intense emotions and see the 
capacity for experiencing them as one of the 



1 . Ancctinc is a drug that paralyzes hrealhing muscles 
creating a near-death suffocation experience as part of 
aversion behavior-modification "therapy.'' used mainly on 
prisoners. 

2. See Peter Brcggin's article "The Second Wave," page 
89 of this book. 



most desirable qualities of the human animal. 
The fact that the psychatric system can extin- 
guish this capacity and docs so for the sake of 
efficiency and control horrifies me. I hope that 
as the specifics of the process arc revealed in 
these pages you will become aware of the anti- 
life properties of mind-control drugs and will 
be equally horrified. 

But these drugs are not only dehumaniz- 
ing, they regularly produce disturbing and 
at times very dangerous ill-effects: 

Every chemical agent introduced into a body, 
irrespective of how specific its effects, has a 
range of side-effects. Psychoactive agents 
(tranquilizers) are no exception to this ride, 
and their side-effects are pervasive and far 
reaching, extending from the person who 
takes them, to his family and others in his 
social network, as well as the community at 
large.' 

It's important that people on "anti- 
psychotic drugs" (Thorazine, Stelazine, 
Navanc, Haldol, and so on ) and people not 

— * 

"Usually people who take the drugs 
simply don't know what's happening." 

on such drugs realize that we are all affected 
by the tons of these drugs being pumped into 
our social-community network. These dru gs 
re i nforcc a socinl modi*! of human bein gs, as- 
animals"n eeding external control. The logic 
seems to go something like this: Non-conform- 
ing behavior - madness people as uncon- 
trollable need for control psychiatry and 
police control pill. Dr. Henry Lennard, 
in his book Mystification and Drag Abuse. 
describes this logic another way : "the tech- 
nology of psychopharmacology is peculiarl 
functional for maintaining an uneasy and 
strained social system." 



3. Ilrnnj rnnnrJ nr I ftTU? 1 ' 1 """-fin "Drugs Versus 
PeopJe-^Pcrspcctivcs on the New I 
Technology."' unpublished manuscript, p^ 
Lennard's book Mystification undtjirf^ />»«■ tNcw York: 
Perennial Library. Harper &>o<Publ . 1971 ). 




/ 



66 



102 MADNIiSS NI-TWOHK NP.WS 



One cog in this shaky, shifting system is 
the medical-psychiatric mystification of 
"patients'Vprisoncrs taking anti-psychotic 
drugs. Usually people who take the drugs 
simply don't know what's happening. If I were 
going to take any "psychoactive" drug I'd 
want to know how it was going to afTcct my 
thinking, feelings (including sexual ), moods, 
energy level, state of consciousness, bodily 
functions and body in general. I would ask 
questions such as how much drug, how often, 
for how long, and why? Later, when I discuss 
the specific effects of specific drugs it will 
become clear why the system is reluctant to 
answer such questions. 

The giving, taking, and selling of psychi- 
atric drugs raises many difficult and rather 
sticky problems of a moral, medical, philo- 
sophical, religious, political, psychological, 
and social nature. For instance: 

1. Can someone who is labeled crazy 
decide for themselves whether or not they 
need and/or want to take an "anti-crazy" 
drug? 

2. If a labeled crazy can can't make a 
decision about psychratric drugs, how much 
information, if any, about these drugs (dos- 
age, side-effects, primary effects, dangers, 
etc. > should be given? 

3. Who is to decide if a labeled crazy 
can or can't make a knowledgeable decision 
about taking such drugs? 

4. Who is to decide who is to decide? 

5. Should you as a person 'physician 
chemically stop a person's "crazy'V'mad"/ 
"psychotic"/"schizophrcnic"/difTcrcnt experi- 
ence, or should you allow the person to 
journey through his or her "madness"? 

6. Would you give or force these drugs 
into people you think are acting "crazy" while 
they say they don't want them, because you as 
a person/physician think they need a drug? 
(They might also tell you they aren't "crazy.") 

7. Would you use force and if necessary 
violence ( such as wrestling a person to the 
floor) in order to give someone you think is 
acting crazy an injection of a drug you think 
they need? 



8. Would you give someone who you 
think is acting "nuts" a drug because you're 
afraid of them and what they might do?/ 
angry at them for what they did? 

9. Would you give a person a drug and 
not tell them what it would do to them? 

10. Would you give a person a drug 
which might cause permanent brain damage 
if used for several years and not tell them? 

1 1 . Would you give a person who was 
feeling upset and coming apart, freaking out, 
a mind-control drug only because there was 
no "safe" place where the person could come 
apart, and then together? 

12. Where's the "safe" place? 

As I said, these arc difficult and sticky 
questions, but they are issues that come up 
every day and may one day involve you. 

Why Caligari? or Just Who Is The 
Violent One? 

As a doctor, on a human level, I was 
trained to: be obedient; toe the "party" line; 
and be over-cautious and over-conservative 
in my thinking, technical ( not humanical ) . 
emotionally blank/yet caring ( how? ) , and 
respectful and frightened of people in power. 

On the medical level 1 was taught to 
speak mcdical-csc. by which people and life 
arc described in certain very specific technical 
terms (they arc "cases." NOT people! ) . I was 
taught how to "regulate" and control the 
amounts of sugar, salts, oxygen and water in 
a person's body. I was taught to fear the worst 
but not to tell anyone. I was taught to show 
submissiveness to those above me in the peck- 
ing order (senior doctors and teachers) and 
to be domineering, arrogant, vain ( in a cold, 
haughty God-like attitude tempered by a de- 
clared humility) and to control those below 
me in the pecking order ( nurses, orderlies, 
hospital workers, "patients," my family — as a 
matter of fact, all humans, except other doc- 
tors). I was also taught to give and to rely on 
giving drills! 

In my psychiatric "training" I was taught 
methods of deception, lying, dishonesty with 



67 




THL CURI 



103 



"Pills were the foundation of my psychi 
atric training ... I saw eventually that 
pills didn't work." 



myself and others, and a moral corruption 
based on the parasitic use of other humans 
(the beginning of an explanation, I think, for 
the high suicide rate among psychiatrists) . I 
was taught how to do a psychiatric "examina- 
tion"/"interrogation"/invalidation and a 
diagnostic "evaluation" ( in other words I was 
taught to see "crazincss" and learn the "ap- 
propriate" labels). I was taught a demeaning, 
embarrassing and destructive ritual of sub- 
missiveness which I now refuse to act out. 
In my psychiatric training 1 was not 
taught how to help people with problems in 
living. I was not taught to be honest, loving 
and responsible to my own morals. I was not 
taught how to handle the anger, fear, despair, 
grief, depression and other aspects of society's 
emotional shit that 1 thought I was preparing 
for. I was not taught how not to rely on mind- 
control drugs, the brutality and inhumanity of 
psychiatric imprisonment, and psychiatric 



"tortures" as ways of catalyzing "changes" in 
people. 

1 soon realized that my teachers didn't 
know what to do with the people they labeled 
crazy. All they knew how to do was to give 
drugs, hospitalize, give shock, and be analyti- 
cal. It was the emperor's clothes, and the 
emperor turned out to be almost every psy- 
chiatrist I met. Thus, I was taught not to 
touch people in "therapy," to be cool, aloof, 
on top; to think, listen, look, and to look right 
— that is, to wear the right clothes, compose 
my face in the right expression, and speak the 
right words. Don't be real, was the message; 
real is human. 

In my psychiatric training I was taught 
methods of control and coercion that were 
based on the pushing of psychiatric drugs and 
the pushing of psychiatric nurses and techni- 
cians onto the emotional "offender." Pills 
were the foundation of my psychiatric training 
( the only thing tangible enough to hold onto 
in psychiatry are pills) . I saw eventually that 
pills didn't work. They don't "cure" anything, 
for when it comes to life and living there is 
nothing to cure. But these pills sure are strong 
"downers." They arc consciousness cement — 
very heavy! They don't help the so-called 
"patient" to clear his or her head and resolve 
whatever the problem was that got her/him 
locked up. The primary effect of drugs like 
Thorazine, Prolixin and Haldol is to slow 
down a person's mind and body: they're 
chemical strong-arms. They arc effective 
"tools" for one person to use in controlling 
another. ( As Thomas Szasz says of medicine: 
Cure? Or Control?) In addition, these drugs 
have side-effects that can be extremely dan- 
gerous to a person's body (permanent brain 
damage, for instance), and often make people 
feel terrible and look weird (although the 
person being drugged usually has not been 
told this). 

But everyone was doing it and I was sup- 
posed to do it too. I ended my inner battle 
over this issue by deciding not to push mind- 
control drugs and to ficht against their 
destructive use. This decision came only after 



68 



104 MADNESS NETWORK NEWS 



I had spent eight months at San Francisco 
General Hospital as a psychiatric intern . 
trying to patch blow-outs with band-aids. I 
spent time and energy there fighting to limit 
the reliance on these drugs by the staff and 
"patients." 

Time and time again I encountered pres- 
sure, anger, fear and disinterest from my 
teachers, co-workers, and "patients" because 
I wouldn't use these drugs in the "normal," 
indiscriminate way. I also wouldn't wear a tie 
and other elements of acceptable garb, such as 
white coat, suit, and bland face. And I did 
touch people, and talk to them without a desk 
between us. I am by nature a touching, hug- 
ging, kissing, loving sexual person. I think 
everyone — like me — needs physical contact 
with other humans. If a person I'm with has 
a problem in living and loving, the best thing 
I can do is be myself — be loving, be honest. 

But to be a psychiatrist today means that 
someone will pay you to give mind-control 
downers. The state will pay you to do it at 
state hospitals and prisons; counties will pay 
you to do it at local hospitals and community 
mental-health centers; individuals or families 
will pay you to do it in your hospital or your 
office. I could never get hired if I said I didn't 
believe in giving psychiatric drugs. They'd 
have no use for me. No Drugs, No Use, No 
Money. The pressure on "shrinks" to push 
psychiatric drugs is enormous. Using these 
drugs is really the only method most psychia- 
trists have of controlling their own fears of 
violent, suicidal or "crazy" people — drug 
treatment plus a dash of hospital or a touch 
of "shock." The system gives no support to 
a psychiatrist who doesn't want to use billy- 
club drugs, although there are other psychia- 
trists who intensely dislike using them. But all 
"shrinks" know that the psychiatric party line 
is drugs, and that if any "patient" of theirs 
with a history of "crazincss" commits an act 
of violence while not being drugged (with the 
"right" drug, of course) they can be charged 
with malpractice ( to say nothing of the poor 
publicity). 

The medical "fraternity" docs not 



indulge in much self-criticism. The "brother- 
hood" seems to believe in an attitude of mu- 
tual support through mutual deceit, dishon- 
esty and silence. "If you can't say anything 
nice, don't say anything at all," seems to be 
the shared rule. I can easily imagine one of my 
psychiatric "brothers" testifying in court that 
my attitudes about psychiatric drugs are irre- 
sponsible, damaging to my "patients," and 
unethical. 

Psychiatric violence and the control of 
psychiatric violence affect us all, not just those 
branded "crazy." All of our personal rights 
and freedoms arc threatened by the alliance 
between law-and-order Nixon politics and the 
psychiatric mind-police.' I am frightened by 
this alliance — frightened by the violence it 



"The system gives no support to a 
psychiatrist who doesn't want to use 
billy-club drugs . . ." 



has made possible in the past, the present 
violence it engenders, and its potential for 
future violence. To mc, the members of the 
alliance, not the branded crazies, are the 
threat. 

Manipulating the Medical Mind. Or. Why Do 
I Do You Like I Do? 

Interesting facts: Twenty-two percent of 
all Americans take legal mind-altering and 
body-altering psychiatric drugs (214 million 
prescriptions is one estimate for 1 970) . 
Ninety percent of a large group of people 
recently surveyed believe that it is better to 
use "will power" than drugs to solve prob- 
lems! 5 

I receive the American Journal of 
Psychiatry, the party organ of the American 



4. See Ihe article by Lee Coleman and David Wong in 
(his section. 

5. Dean J. Mannhcimcr. ct til . "Popular Altitudes and 
Beliefs about Tranquilizers." Amrrtuin Journal of Psyclna- 
rrv.vol. 130. no. II (November WTS). 



69 



THii cum; 10 



Psychiatric Association. One of the many 
lessons to be learned from this "trade" journal 
is the power of madison-avenue brainwashing. 
Psychiatrists arc constantly being bombarded 
by repetitious visual images and verbal slo- 
gans that arc part of the drug companies' 
continuous program to indoctrinate, educate, 
convince, and reinforce psychiatrists into 
pushing psychia/Wcfc pills, misleadingly and 
deceptively called "medications" or "tran- 
quilizers." "Tranquilizers" don't tranquilizc; 
they drug in ways that slow down mind, body 
and gut, producing a state of spiritual, psychic 
and digestive constipation. They block feel- 
ings, often make muscles rigid .and generally 
reinforce people in wearing socially accept- 
able masks. 

Each year I receive at least fifty pounds 
of printed material, pens, coffee cups, paper- 
weights, and all sorts of other trash sent by 
the drug companies to either buy me, convince 
mc. guilt mc, or overwhelm me into pushing 
these psychiatric drugs. Just as the oil com- 
panies reap incredible profits from the media- 
created energy crisis, so the drug companies 
such as Squibb, Sandoz and Hoffman- 
LaRochc make incredible profits and wel- 
come the growth of the mental-health 
"industry." „ — 

"Tncphaj-maccuticalcoinpa nicsout- \ 
perform _all othermajor Am erican indu stries 
in net profit after taxes ."* "It is estimated that I 
trie ethical prescription drug houses spend 
$ 1 .2 billion dollars per year on advertising 
and promotion . . . which is nearly four times 
what they spend annually on research and 
development of drugs." 7 The bulk of that 
money is spent on the sexist, prejudicial and 
deceitful ads that clutter and financially sup- J 
port medical-psychiatric journals to the tune I 
of $4,000 per year per physician!' J 

The $ 1 .2 billions also includes the sal- 
aries of 2 1 ,000 drug detail men, whose "sole 
job is to make periodic calls on physicians. 



6. James Goddard. 'The Medical Business," Scientific 
American (September 1973), p. 161. 

7. Goddard. p. 162. 

8. Goddard. p. 162. 



"The pharmaceutical companies out- 
perform all the major American indus- 
tries in net profit after taxes." 

pharmacists and hospital purchasing agents to 
push their firms' products."" The detail men. or 
"pushers," hand out free pills to open-handed 
medical students and doctors, applying the 
super-humble, fast-sell, quick-kill technique 
of salesmanship (they arc all men) to make 
sure that pills arc popped. Tncsc salaried and 
highly legal pushers exert a powerful influence 
on the continued drug-pushing practices of 
physicians. 

Looking at the incredible increase in pre- 
scription drugs — $ 1 .9 billion in 1 962 to 
$4.11 billion in 1971 — one sees that the 
tranquilizers and mood-modifying drugs 
jumped 1 36 percent in manufacturers' sales 
in nine years. The growth rate and gross sales 
arc greater than those of all other types of 
drugs. 

Incidentally, a scandal popped up the 
other day. It seems that the A.M. A. 
(American Medical Association) retirement 
fund has put about $10 million into drug 
company stocks; and the drug companies 
supply one-quarter of the A.M.A.'s $32 mil- 
lion budget. The pharmaceutical big-boys 
pressured the A.M. A. into abolishing the 
Council on Drugs of the A.M. A. after the 
Council had published a drug-eyaluation 
handbook. This handbook stated that the 
drugs most profitable to the pharmaceutical 
industry were "irrational" and that their use 
was "not recommended." Another facet 
of the A.M.A.'s questionable image 
was the arrest and imprisonment of Dr. 
John Kernodle, past president of the A.M. A., 
for bank fraud in February, 1 974. The con- 
flict of interest of these hypocritical hypocrats 
affects us all, for these are the people pushing 
tons of mind-control drugs into our eco- 
system. 

This is business, sick busine$$. 

9. Goddard. p. 162. 



70 



106 MADNISS NETWORK NEWS 



Who Gets Drugged? 

Children who wet beds get drugged. 
Children who get labeled "hyperkinetic," 
"behavior problems," "autistic," "crazy" get 
drugged. Adolescents who arc "wild," "pro- 
miscuous," "pre-dclinqucnt," or "delinquent" 
get drugged. Women who are "anxious," 
"depressed," "menopausal," or "mad" get 
drugged. Men who are "violent," "criminal 
types," "angry," "tense," senile, or "insane" 
get drugged. 

Anyone who goes to a community 
mental-health center is likely to get drugged. 
Anyone who goes to a psychiatrist and asks 
for drugs gets drugged. Anyone who goes to 
a psychiatrist and doesn't ask for drugs may 
get drugged. Anyone who "enters" a 
psychiatric hospital has about a 95 percent 
chance of getting drugged. The poor, the non- 
white, the women, the "deviants" ( whether 
criminal, "crazy" or merely unconventional ) 
arc more likely to be force-drugged. People on 
the west coast get legally drugged significantly 
more than people on the cast coast or in 
Europe, and women get legally drugged twice 
asoftcnasmen.' 

In psychiatric hospitals anyone who 
shows intense feelings — especially anger — is 
almost guaranteed drugs, seclusion and at 
times shock "treatment." People who are with- 
drawn, "uncommunicative," not eating regu- 
larly, hearing voices, thinking someone is 
after them, or otherwise acting in a manner 
that people in the system could label "abnor- 
mal" or "bizarre" may get drugged. 

More psychiatric drugs are prescribed by 
general practitioners and other non-psychatric 
physicians than by psychiatrists. These non- 
psychiatrists usually use the weaker psychi- 
atric drugs (minor tranquilizers and seda- 
tives). This is explained in part by the fact 
that most visits to doctors (estimates range 
from 50 to 75 percent) are for "non-organic" 
psychosomatic complaints. The current trend 
in American medicine is to rely on pills to 

10. Hugh J. Parry. Mitchell B. Bailer. Glen D. Mellinger, 
rial., "National Patterns of Psychotherapeutic Drug Use." 
Archives o\ General Psychiatry, vol. 28 ( 1973 ). pp. 769-83. 



"cure," even if the doctor can find nothing 
physically wrong. The stronger psychiatric 
drugs (anti-psychotics, anti-depressants, and 
Lithium) arc still mainly pushed by psychia- 
trists and the psychiatric system. 

Many individual factors affect the 
process of psychiatric drug-pushing: the indi- 
vidual style of the prescribing doctor; the 
setting within which the drug "deal" takes 
place (i.e. an M.D.'s private office, a private 
hospital, a state hospital, a veteran's hospital, 
a jail, a halfway house, a home etc. ) ; whether 
or not a person actively asks for drugs; 
whether or not a person actively refuses or 
resists the drugs; how economically well-off 
the person looks; how well-educated the 
person seems; and so on. 

Many people exposed to the psychiatric 
system have been force-drugged — that is. a 
pill, liquid or injection of some psychiatric 
drug is given despite their protestatons. I do 
not think that the F.D.A., A.M. A.. A.P.A. 
(American Psychiatric Association) or pro- 
fessionals in the health and mental-health 
system are controlling or will control this 
abuse of psychiatric drugs. I think the only 
solution to the problem of forced drugging is 
the creation of laws which guarantee an indi- 
vidual the absolute right to refuse any psychi- 
atric drug. 

Context /Drug Chart 

Most people don't realize/aren't told 
that several different groups of drugs are 
passed off under general headings such as 
"tranquilizers." These groups, or drug famil- 
ies, are based on the chemical shape of the 
drug. All drugs with a similar chemical shape 
are in a particular drug family. It is the 
chemical shape of the drug that determines 
how it will affect your body, mind, and soul. 

Psychiatric "druggists" have always 
admitted that the different drugs in a particu- 
lar family arc very similar. Psychiatrists in 
training are told to get familiar with just a few 
of these drugs, since so many of them are 
almost identical, and then to prescribe the few 
they know. In many cases this procedure 



71 



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Controlled Drug Delivery OfeyOUaffiOlCe. 

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0LCKIN- DBCANOATE )2SWtol 

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choice tor prompt rapport 






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72 



10fi MADJSESS NETWORK NHWS 



!■ > «J» t^KanMiM^n,!-. . x?\« fA'MWN 



JU^1UI)WI!.WWgT- 



I 



- 



Anti-Psychotic Drugs 
(Major Tranquilizers) 

Anti-madness supcr-downcrs 



[Druf: 


Chart] 




Phenothiazines: 


Thorazine 


Rcpoisc 




Stclazinc 


Sercntil 




Mellaril 


Quidc 




Prolixin (Pcrmitil) 


Phcncrgan 




[Sec Appendix) 


Vcsprin 




Trilafon* 


Dartal 




Etrafon* 




Dutyroplicnones: 


Haldol 




Thioxanthenes: 


Navanc 
Taractan 





Anti-Parklnsonian Drop 

Antidotes to muscular side-effects 
of the anti-psycholics 



Artanc 

Kcmcdrin 

Akincton 



Cogcntin 
Benadryl 
Trcniin 



Minor Tranquilizers 
(Anli- Anxiety Drugs) 

Mini-downers with alcohol- 
like effects 




Librium 
Valium 

Mcprobamatc (Miltown, 
Equanil)** 


Vistaril (Atarax) 

Scrax 

Ultran 

Tranxcnc 


Sedative-Hypnotics 
Sedating and sleep drugs 


Non-Barbiturates: 
Barbiturates: 


Placidyl 
Doridcn 
Noludar 

Quaaludc (Parcst. Sopor 
Somnafac, Opiimil) 

Seconal 
Tuinal 

Phcnobarbital 
Amytal 


Chloral-hydrate (Bcla- 

clor, Noc-tcc) 
Scdamyl 
Dalmane 

Luminal 

Butibcl 

Nembutal 


Mood Modifiers 

Anti- Depressants ("Uppers") 


Trycyclics: 
Amphetamines: 


Elavil 

Vivactil 

Tofranil 

Norpramin (Pcrtofran) 

Benzedrine 
Dexcdrine 


Triavil 
Avcntyl 
Sincqiian 
Adapin 

Dcsoxyn 
Ritalin 



Aali-Manic-Deprcssivcs 



"Special- Drugs 



Lithium (Lithane, 
Eskalith, Lithonatc) 



Methadone: 



Antabuse: 



Anectine 
(Succinylcholinc): 



given to heroin addicts as a replacement habit, 
in pill form. 

given to alcoholics. Any alcohol consumed by a 
person on this drug produces a violent 
sickness which can be fatal. 

paralyzes breathing muscles creating a near-death 
suffocation experience. Used mainly on prisoners 
as a behavior-modification "lhcrapy"/torturc. 




I 



73 



THE CURE 



Premarin 
(estrogen): 



given (o menopausal women. 



•These drugs are combinations of two drugs, 
an anti-depressant and an anti-psychotic. For 
example, Triavil contains two dangerous drugs: 
Trilafon. an "anti-psychotic." and Elavil, an "anti- 
depressant." Thus Triafon + Elavil = Triavil. This 
simple-minded equation indicates the mental level of 



those inventing drug names. Drug names arc in them- 
selves a study of money-mindcd-media-medical-mind 
manipulation, a whole separate trip. 

••Terms in parentheses are different names for 
the same drug. 




becomes rigidified. One psychiatrist I knew at 
San Francisco General always gave the same 
two drugs to any "patient" he could get his 
hands on — Tofranil (an "anti-depressant") 
and Mellaril (an "anti-psychotic"), no matter 
what his "patienf'/captive said or did. Many 
physicians express a similar attitude : "If 
you're crazy you need Drugs"; "if you have 
problems you need Drugs"; "if you feel too 
much and talk too much, you need Drugs"; ad 
nausaum. 

Opposite is a chart of the various drug 
families, so you know where we are going. 

Recipe 

You start with an anti-psychotic pill 
such as Thorazine, and then you add a touch 
of a minor tranquilizer such as Valium or 
Librium. To this concoction add one of the 
anti-Parkinsonian agents, Artanc or Cogcntin 
(to counteract the spasticogenic side-effects 
of the anti-psychotic ) . Then, of course, there's 
always a dab of depression, so an anti-depres- 
sant or mood-elevator (Elavil, Vivactil, etc. ) 
is added (or for some "speedy" souls ampheta- 
mines or Ritalin are given as "psychic 



ZJ+ 



energizers") . And since no one knew if the 
thing they called a convulsion was an epileptic 
fit ( a convulsion ) or a temper tantrum, an 
anti<onvulsant such as Dilantin and/or 
Phenobarbital is given to moderate emotional 
modulation. Then, of course, we can't forget 
the nightcap, so here comes a jumbo green 
Chloral-Hydrate, or the "lucky" few may 
score a downer — a red — namely, a sedative- 
hypnotic (Seconal is soporific!). 

Pills make money for people with money, 
while making malleable mush of the minds 
of the many labeled mad, labeled bad. 
Time and time again I have seen the "psychi- 
atric curse" being forced on people. The curse 
goes like this: "If you don't take your medica- 
tion you will go crazy and have to go to the 
hospital." Nowhere in psychiatric research is 
there a study of the effect of this curse (often 
called concern) and the destructive depen- 
dence it fosters on both the pill and those who 
give it. It makes sense that if a physician or 
some other psychiatric authority figure tells 
you repeatedly that you will go crazy if you 
stop taking your Thorazine, you will be fright- 
ened to stop. You will be frightened if you do 



74 



1 10 MADNESS NETWORK NEWS 



stop and frightened, because of the strange 
happenings to your body and spirit, if you 
don't stop. 

If you do stop taking psychiatric drugs, 
your fear and confusion around stopping, in 
addition to the real problems you already 
have, could be labeled a relapse or deteriora- 
tion by your keepers. This interpretation 
would support the psychiatric opinion and 
belief that you need such drugs. What a catch- 
22 mind-fuck. I've seen it happen many times. 

ODE TO PILL-BOX POWER 

My mind means mush, mashing, marching, 

and 

moving more meaninglessly in a mass and 

morass of moldy medicated metaphors. 

I don't believe in using psychiatric drugs 
myself or giving them to others. I believe that 
these mind-control drugs have few construc- 
tive uses. I don't and won't push these drugs! 

[The Drugs] 

A nti-Depressants 

There arc two kinds of anti-depressant 
drugs: trycyclics and amphetamines. 

The trycyclics (the term refers to the 
chemical structure) were originally developed 
during the search in the 1950s for new anti- 
psychotic drugs. They include such drugs as 
Elavil, Vivactil, and Tofranil. Their chemical 
structure is similar to Thorazine and they 
have a lot of the same non-muscular side- 
effects ( to be discussed ). To my mind, these 



drugs arc second cousins to the anti-psychotic 
drugs. I have never been convinced that they 
were able to help a depressed person any more 
than a placebo, or sugar pill, would. Next to 
Lithium, these drugs arc the most dangerous 
of the psychiatric drugs in terms of their 
ability to kill when taken in overdoses (cither 
accidentally or on purpose ) . These drugs are 
supposed to counteract depression. Thus it is 
ironic that a depressed person, who is likely 
to try suicide, is given a drug that is most 
likely to kill if an overdose is taken. ( As a 
side note, Tofranil is now being given to chil- 
dren who are bed-wctters — a practice that 
makes as much sense as attacking a mosquito 
with a submachine gun.) 

Amphetamines (speed) used to be used/ 
abused more often by psychiatrists than they 
arc now. They were prescribed for depression 
and also were commonly given to people 
taking anti-psychotic drugs to counteract the 
scdating/zombifying effects of the latter. 
These drugs really did stop depressions, but 
only temporarily. What would happen later is 
history by now: People became addicted to 
amphetamines; they had "paranoid"' episodes 
of a very bizarre nature and experienced even 
more severe depressions when the drug was 
stopped. 

Psychiatrists learned the hard way not 
to prescribe these drugs. But in place of true 
amphetamines we now have Ritalin, a first 
cousin to amphetamines, which is still being 
used as an anti-depressant, and is also given 
to young children who are labeled "hyperac- 



ute Drug Hit Parade (1968) 

(The most widely prescribed drugs in 1968. 
From The New Handbook of Prescription Drugs, by 
Richard Burack, M.D.) 

10% 
Artane 
Noludar 
Tofranil 



33% 


15% 


Elavil 


Mellaril 


Equanil 


Libra* 


Mcprobamale 


Miltown 


Librium 


Placidyl 


Thorazine 


Stclazine 




Triavil 



7% 

Atarax 

Chloral-hydrate 

Noc-lcc 

Vistaril 



% of all drugs prescribed 



75 



Till: CUKE 111 



Some Drug Companies and Their Big Sellers 

Smith. Kline & French— Thorazine, Stclazinc, 

Eskalith 
Squibb — Prolixin 

Hollman-LaRoche — Valium, Librium, Dalmanc 
CIBA— Ritalin 

Sandoz — Mellaril, Screntil, Noc-tec 
McNeil— Haldol 
Dow — Quicle 
Pfizer — Navanc, Vistaril 
Merck, Sharp & Dohinc — Triavil, Vivactil, 

Cogcntin, Elavil 



tivc" (another very destructive label). Ritalin 
has its own set of side-effects, the most 
prominent of which arc nausea and insomnia. 
Several studies have also indicated that Rit- 
alin retards normal growth ( height and 
weight) in children. Children area very vul- 
nerable and unprotected group when it comes 
to drugs. 

Lithium 

Lithium isn't really a drug: it's a metallic 
clement like sodium, copper or zinc and is 
given as a salt (table salt is NaCl, sodium 
chloride; lithium is made as lithium carbon- 
ate ). It is one of the newest of the psychiatric 
control tools and is now being tried for all 
sorts of problems, most frequently for "manic- 
depression" or "recurrent depressions." 
Lithium is a very dangerous chemical ; blood 
tests must be made every day for the first few 
weeks the drug is taken, and then every month 
as long as it is used, to make sure there is not 
too much or too little of the chemical in the 
blood. If there is too little it doesn't "work"; 
if there is too much the person becomes very 
ill with nervousness, tremors, frequent urina- 
tion, diarrhea, drowsiness, muscle weakness, 
lack of coordination, vomiting, ringing in the 
ears, blurred vision, a drunken walk. Uncon- 
sciousness and eventually death occur if the 
person experiencing these reactions is not 
hospitalized. The above may occur if the 
person on Lithium becomes sick and starts 
vomiting, has diarrhea, is not eating regularly, 
or has kidney disease. In addition, even if the 



person is getting the supposed right dose the 
thyroid gland may be disturbed with goiter. 
Other parts of the body may be affected as 
well. Recent investigations indicate that 
Lithium can damage the fetus, and thus 
shouldn't be used during pregnancy. 

Lithium is marketed under the names 
Lithane. Eskalith, and Lithonatc. It is often 
given "prophylactically" to "prevent" mania 
and depression. So once someone decides 
you're cither a "manic-depressive" or a "recur- 
rent depressive" you "must" take this drug for 
the rest of your life — a good example of 
psychiatrically created drug dependence. 

Since Lithium is a "young" drug, little is 
know about how it might affect a person's 
body over a long period of time (years). It is 
now being tried on people who have not been 
"cured" by other drugs, for example alco- 
holics. It supposedly controls and prevents 
wide "swings" in mood. Whenever a drug is 
used to control behavior, the individual being 
controlled loses part of his/her humanncss in 
exchange for the "control," and control comes 
at a cost! Given the medical mentality of pill- 
cure, Lithium-abuse by the psychiatric system 
is in my opinion now becoming a reality. 

Minor Tranquilizers 

This category includes Valium, Librium, 
Miltown and a scries of other drugs that have 
been called anti-anxiety drugs or muscle- 
relaxants. They arc very similar to the class of 
drugs labeled sedative-hypnotics but arc given 
to counteract nervous tension and anxiety 
rather than to sedate and induce sleep. They 
are very similar in effect to alcohol and are 
widely abused by medical workers, profes- 
sionals and the public in general, since some 
people like getting "stoncd"/drunk on them. 
These are the drugs that doctors of all kinds 
give to their complaining, unhappy, tense and 
psychosomaticized patients. 

In October 1 973, Librium and Valium 
were officially classified as abused drugs by 
the Drug Enforcement Administration (a 
newly created drug-control agency of Nixon's 



76 



112 MADNESSN F.TWOR K NEWS 



'The main problem is addiction." 



Justice Department ) . Prescriptions for drugs 
in this category cannot be legally refilled more 
than five times within a period of six months 
( some control ! ) and tighter controls now 
exist to prevent theft or illegal sales of these 
drugs. Roche Laboratories, the sole producer 
of these extremely profitable drugs, has been 
fighting against such controls in court. It 
seems obvious that Roche is more interested 
in their profits than in your health. 

Sedative-Hypnotics 

This category consists of barbiturates 
and similar non-barbiturate drugs; these are 
the sedative and sleeping pills. Chemically 
they are very much like the minor tranquil- 
izers; they affect the body in similar ways and 
create similar problems. The main problem is 
addiction. The non-barbiturates, although not 
classified as habit-forming, are at least 
psychologically so in my experience. The 
barbiturates are physically addicting, and if 
they are stopped suddenly after a period of 
constant use (several months), withdrawal 
reactions occur — nausea, sweating, shaking, 
muscle cramps, vomiting, diarrhea, convul- 
sions, and so on. In other words, cold turkey. 
These drugs don't solve sleep problems; they 
merely substitute a chemical sleep problem 
for a natural one. The risks of addiction and 
subsequent withdrawal don't seem to make 
the substitution a very profitable one. 

It is becoming clear that the non-barbitu- 
rate sedative-hypnotics, in particular Quaa- 
ludc (methaqualone), can be physically as 
well as psychologically addicting. For years 
the drug companies have been pushing Quaa- 
ludc, saying it wasn't addicting; however, the 
Drug Enforcement Administration has pro- 
posed that Methaqualone be classified as a 
narcotic, in the same category with Morphine 
and Demerol. 

It has been my experience that the minor 
tranquilizers, especially Miltown (Equanil), 



can be physically addicting, even though these 
drugs are not considered so by the medical 
profession. And even though Librium and 
Valium aren't considered physically addict- 
ing, the widespread daily reliance on these 
drugs amounts to a psychological addiction, 
which is supported and encouraged by drug 
companies and physicians. 

Anti-Psychotic Drugs — "The Big Guns" 

Thorazine . . . Paregoric for the mind?" 
The bell rings, or there is an announce- 
ment over the public address system of the 
ward, or there is a staff member in a white 
coat calling out your name, or you simply 
see everyone slowly making their way to the 
"nursing" station. 

"Take it, your doctor ordered it. Come 
on, that's a good boy/ girl. It will help you. 
You want to get well don't you?" 

"A certain degree of practiced art in 
interpersonal persuasion is necessary in deal- 
ing with patients who resist indicated 
medication." 12 Enter Thorazine (or some such 
"anti-psychotic" drug — sec the Drug Chart), 
stage right, as an energy binder. (Have you 
ever been in driver's education class in high 
school where the gym teacher in the front scat 
of the driver-ed car teaching you how to drive 
a stick-shift Plymouth is smoking a foul cigar 
and the smell combines with that of burning 
brakes because your friend who is driving 
forgot to release the emergency brake? That's 
what Thorazine is like, only the brake is never 
released and you just have to drive around like 
that. ) I have never been "psychotic," but 
when I took 50 milligrams of Thorazine ( a 
small dose) I felt overwhelmed by the blahs. 
I felt tired and lethargic, motivated to do 
nothing. My thinking was turned down from 
7 8 to 1 6 rpms, my mouth got dry and I just 
didn't care all that much about anything — 
like being in the Lexington Avenue subway in 



1 1. Paregoric is an opium concoclion used lo Ireal diar- 
rhea. Paregoric by Iradinon is used especially for children. 

12. D. Klein. M.D., and J. Davis. M.D.. Diagmmi ami 
Drue Treatment ul Psychiatric Disorders (Baltimore: Wil- 
liams 4 Wilkins. 1969), p. 18. 



77 



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wewatr, 



THE CURE 113 

ana— a 



New York City at rush hour and not being 
sure if I was standing or being held. This 
experience was similar to those of a group of 
eight "non-psychotic" psychiatric workers 
who volunteered to try the drug ( after having 
given it to others). They had no desire for a 
repeat performance. 

If I had taken 100 milligrams of Thora- 
zine I would have been asleep in half an hour 
(and I have a lot of energy). Yet I have seen 
people who were given 3,000 milligrams a 
day, although an average is 400 a day, in an 
effort by their doctors to control their be- 
havior and "normalize" their thinking. 

The rationale for using an anti-psychotic 
drug is that it will ( 1 ) "normalize" thinking, 
(5) reduce the intensity of emotions, and (3) 
sedate and slow down a person so that he or 
she can't get excited. Thinking is slowed down 
— and at high enough doses "dissolved" — so 
that so-called "crazy" or "delusion al" think ing 
i s prevented ( along with all other kinds of 
thinking — including creative thihTongT 
fcmotions arc blllrticd, pushed down. 1 he 
result is some degree of (often total ) indiffer- 
ence and apathy. Sterile, zombie-like person- 
alities result when indifference is combined 
with the drug's sedating effects. The sparkle, 
vitality and exuberance of an alive human 
being arc cut off by these drugs. Is this desir- 
able? Is this a cure? Is this normalcy and 
health? 

Every individual reacts differently to 
drugs. Thus the same dose of the same drug 
will be experienced differently by two indi- 
viduals, or by the same individual at two 
different times. The effect depends on height, 
weight, sex. age, personality, the condition of 
the liver, and so on. Yet on countless occa- 
sions I have seen individuals getting so much 
of these "robot" drugs prescribed without 
concern for the unique circumstances of the 
individual body, that they hardly seemed 
human. Even in the so-called "proper" doses 
these drugs, to differing degrees, destroy spon- 
taneity, playfulness, and emotionality — to mc 
the rcalncss of human beings. 



"The sparkle, vitality and exuberance of 
an alive human being are cut off by these 
drugs. Is this desirable? Is this a cure? Is 
this normalcy and health?" 

Sidc-EQccts 

Aspirin is taken for headaches, yet it 
always produces some stomach irritation and 
can cause stomach bleeding and even ulcers. 
Thalidomide was taken by pregnant women 
for sleep and it caused horrible birth defects. 
Birth-control pills prevent fertilization but can 
also cause blood clots. Similarly, psychiatric 
drugs are taken/given for "crazincss," but 
they produce many undesirable bodily reac- 
tions. These reactions arc called side-effects. 
In general, the side-effects of the anti-psy- 
chotic drugs can be classified as muscular — 
affecting the muscles and the brain's muscle- 
coordination centers; and non-muscular — 
affecting other parts of the body such as eyes, 
mouth, salivary glands, intestines, skin, and 
soon. 

Side-cfjects occur with all drugs. 

Non-Muscular Bodily Side-Eiflcts of 
Anti-Psychotic Drugs These non- 
muscular side-effects can be roughly classified 
as common and uncommon, according to 
how frequently they occur. Although they 
don't happen to everyone taking these drugs, 
they might happen to you if you decide to take 
a drug like Thorazine; you never know. 
Before I put any drug into my mouth I find 
out what it will do, what its dangers arc. and 
what it won't do, and what all the alternatives 
to using it arc. Respect your body! 

The common non-muscular bodily side- 
effects follow. (Note: You can develop a 
"tolerance" to these side-effects, which means 
your body eventually adapts to the drug and 
its side-effects arc experienced less intensely. 
It usually lakes weeks, sometimes months, for 
such tolerance to develop). 

1. Sedation. You feel tired, drowsy, it's 



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78 



114 MADMI-SS NF.TWORK NI-WS 






[Dituc Flow Ciiakt] 

mm, 

CRAZY BEHAVIOR 



Psychiatric Jail 



,7V Chemical Mind Control 



>H 'l 



VU Desired EQcct' 

f 71 ■ »• ' 

'•' I; 1 Thinking slowed ■ ; "'■ | 

1 1\ -Feelings blunted ', '• 

( 'I ) ' IndifTcrcncc • ', ■>,', 
■'/!■ f '/if / Low energy level 
/( A It I Desires eliminated 

tf/'i // /.,..■-! 



Semi-Temporary 

Side E [J eels 

I ■• • '/ 

* i 4\ 
Body Reactions ' . , . 

Dry Mouth , j ;■•-■ 
Blurred Vision ,i'- : . 

Nausea 

Constipation 

Apathy 

Difficulty Urinating 

Sedation 

Impotence 

Hepatitis 

Periods Cease 

Etc., etc. 



Ulif 



I. 



1 Permanent Damage 



\ 



' jl Tardive Dyskinesia 
•' ■ Brain damage 
Abnormal muscle movements, 
especially around the mouth 



— I 

Semi-Temporary 
Side ESects 



I 



Muscle Reactions 

Parkinsonism 

' Dystonia (Cramps) 

Akathisia (Mr. Machine) 



Treatment: 
Anti-Parkinsonian Drugs 

Artane 

Akincton 

Cogcntin 

Benadryl 



1 








V Catch 22: 

These drugs also have 

undesirable body 

reactions, causing a 

compound problem 







Ig gasBBaBaH B HmBEaB BBs^^ 



79 



THE CURE 115 



hard to keep your eyes open; you're "blahed- 
out" in lethargy. 

2. Dry mouth and throat. This usually 
leads to problems in talking, swallowing, and 
kissing ( if you can get that far). This may 
cause you to choke on food at the dinner table. 

3. Blurred vision. Especially when you 
try to focus on objects that are close, like a 
newspaper, or this book. 

4. Constipation. Seems like every part 
of you is slow! 

5. Weight gain. Fat head, fat body. No 
one knows why this happens — slow metabol- 
ism? The gain is usually ten to twenty pounds. 

6. Listlessness. apathy, depression. 
With these it's hard to know what's caused by 
the drugs, what's caused by the people giving 
the drugs and the environment, and what's 
your own responsibility. 

7. Dizziness/fainting upon standing. 
This is called "orthostatic hypotension" in 
medical jargon and is caused by the anti- 
psychotic drug's interference with your body's 
normal blood-pressure control system. To 
protect yourself once you notice this happen- 
ing, you should start to stand up slowly if you 
have been sitting or sleeping, and make sure 
that as you stand up there is someone or 
something next to you that you can use for 
support if you start to feel dizzy. This can be 

a really frightening experience and is even 
more of a mind-fuck if you don't know what's 
happening and why. It's most likely to happen 
during the first few weeks on these drugs, as if 
that's a consolation. In older people with . 
heart disease this is particularly serious. 

8. Nausea. How unpleasant! 

9. Vomiting. Even more pleasant! 

10. "Loss" of sexuality. Inability to have 
an erection, ejaculation, or orgasm (especi- 
ally with Mellaril) and a loss of sexual desire. 
This happens to men and women. 

1 1 . Nasal congestion. Stuffed nose! 

12. Changes in Electroencephalogram 
(E.E.G., brainwave tracing). Obvious 
changes occur, which reflect changes in con- 
sciousness produced by these drugs. These 



changes last up to three months after the 
drugs are stopped. This is in part explained 
by the slow rate at which the body decom- 
poses these drugs: accumulations of these 
drugs remain in various parts of the body, 
especially fat. after stopping. The changes in 
consciousness reflected in the E.E.G. occur 
in everyone taking these anti-madness drugs. 

The uncommon, non-muscular side- 
effects of anti-psychotic drugs are: 

1. Skin reactions: (a) An allergic type 
of sunburn when skin is exposed to the sun. If 
this happens (usually with high doses), all 
you can do is avoid the sun. clothe all exposed 
skin, use a special cream to block your skin 
from the sun, or stop taking the drug. ( b) 
Skin rash of an allergic nature, (c) Blue-grey 
pigmentation of skin exposed to sun after 
several years of drug use. 

2. Difficulty urinating. Difficulty in 
starting and stopping urination, dribbling, 
and at times painful swollen bladder because 
urination is blocked. This happens most often 
with older men. 

3. Menstrual irregularities. Irregular 
periods or a complete stopping of periods. 

4. Secretion of milk by the breasts. This 
can happen to men and women. In some 
people there is "only" a swelling of the breasts. 

5. Increased susceptibility to epileptic 
fits. This is mainly true for those people who 
have a history of epileptic fits. The increased 
susceptibility is dependent on how much drug 
is taken. The more drug you take the greater 
the chance of a seizure. 

6. Hepatitis with jaundice (yellow skin). 
An allergic type of hepatitis (liver disease) 
which goes away if you stop the drug. This 
occurs during the second to fourth week on 
the drug, and happens especially with Thora- 
zine. 

7. Eye difficulties. Pigment deposits in 
the retina can occur with high doses of Mella- 
ril after several years. Opacities or cloudiness 
of the cornea and lens can occur with high 
doses of Thorazine taken for years. These eye 



80 



116 MADNESS NETWORK NEWS 



changes can be detected by an eye examina- 
tion every year; if these changes occur the 
drug should be stopped. 

8. Decrease in white blood cell count 
leading to frequent infections. This condition 
is rare, very dangerous, and can be fatal if the 
drug isn't stopped and the right antibiotics 
aren't started. This is called agranulocytosis 

( no white blood cells ) and usually occurs 
from the fourth to tenth week on the drugs. It 
signals its appearance by an infection, often a 
sore /strep throat. 

9. Changes in Electrocardiogram 
(E.K.G., heart tracing). These changes are of 
unknown significance, but obviously are not 
at all desired. 

10. Paralysis of the intestines. Rarely a 
person will stop having bowel movements 
because of a paralysis of the intestines, called 
"paralytic ileus." This is a medical emergency. 
All anti-psychotic drugs should be stopped 
immediately and the person hospitalized. 

11. Very rarely, people taking these 
drugs have died suddenly, without any evi- 
dence as to why death occurred. It is impos- 
sible to say for sure, but the possibility of 
heart failure and/or asphyxiation because of 
these drugs remains. 

Muscular Side-Effects of Anti-Psy- 
chotic Drugs Charles Atlas spoke of 
"dynamic tension"; Wilhelm Reich spoke of 
Body Armor ( as do Drs. Lowen, J anov and 
Rolf in their ways) . These terms refer to the 
way a person controls and expresses feelings 
through muscular tension. We all talk of a 
pain in the neck and know what it's like to 
walk, talk, look, pick our nose, scratch our 
ass, ride a bike, thread a needle, cat, and make 
love. What we all don't know is what it's like 
to perform these "normal" activities when we 
are having a bad reaction to an anti-psychotic 
drug, when painfully or unpainfully our 
body's muscular control system is so distorted 
that we are experiencing constant shaking in 
our fingers, or muscular incoordination and 
spasticity, or muscle stiffness and rigidity, or 



some such trip. 

In other words, did you ever try to park 
a Cadillac Eldorado when the power steering 
was dead? Or climb a narrow flight of stairs to 
a Chinese restaurant with a hundred-pound 
bag of rice on your shoulders? Or swim with 
all your clothes on? Or live in raspberry jcllo? 
Or be the rusty tin man/woman in the Wizard 
of Oz before an oil and lube job? Or oops 
there goes my right arm, or why doesn't my 
hand move, or oops where did my eyes go as 
they get stuck in an upward gaze (called ocu- 
logyric crisis by the medical establishment). 

There arc two types of muscular side- 
effects. One type is temporary; the effects 
disappear after the anti-psychotic drugs arc 
discontinued, or can be toned down or 
stopped by the use of other drugs. The second 
type of reaction. Tardive Dyskinesia (T.D.). 
is permanent. T.D. will be discussed in a later 
section. 

The temporary muscular side-effects are 
the most striking and horrifying aspects of 
the anti-psychotic drug experience. Three 
types of distortions of the body's muscle- 
control system occur: 

1. Weird, uncontrollable and involun- 
tary movements of some part or all parts of 
the body (hands, feet, fingers, toes, mouth) 
with or without an inner sensation of having 

a machine in your guts that won't stop. This is 
called Akathesia. and,asyou can imagine, 
anyone experiencing this looks very strange — 
spastic, and constantly moving. 

2. Sudden bizarre muscle spasms 
(cramps), especially of the head, neck, or 
eyes. These arc called acute dystonia reac- 
tions, and are very painful and horrifying. 
They do much to convince a person of his/her 
"illness." 

3. A general increase in muscle tension 
which causes total body stiffness, rigidity, and 
slowness plus shaking (tremors) of the hands, 
and a hunchback, robot-like posture. This 
condition is called Parkinsonism, because of 
its similarity to the naturally occurring 



81 



thi; curi; 117 




Parkinson's disease. So all you need to do is 
act crazy and you can get a chemical, syn- 
thetic version of a naturally occurring disease. 
Great! 

The bizarre muscle spasms (acute 
dystonic reactions) arc the most frightening 
of these muscular side-effects and usually 
occur within the first twenty-four to forty- 
eight hours after the drugs arc taken. Oculo- 
gyric crisis, where one's eyes get painfully 
stuck in an upward gaze, is one example of 
this kind of reaction. Another is wry neck, 
where the head and neck get stuck turned 
cither to the left or right as if the person were 
trying constantly to kiss the back of his/her 
neck. Often the tongue and mouth muscles are 
affected so that speaking is garbled, and in 
some instances the mouth cannot be opened 
at all. Cramps of the facial muscles may 
occur, producing strange facial expressions. 
At times the legs may be affected making 
walking difficult if not impossible. Less fre- 
quently all the muscles along the spinal 
column go into spasm, producing an "anti- 
foctal" position which is very painful. These 
reactions seem to occur more frequently in 
young people, especially men. It's impossible 
to know who will have such a reaction; some 
people arc just more sensitive to these drugs 
in this way. 

Then there's Akathcsia: "A neurosis 
characterized by an inability to remain in a 
sitting posture: motor restlessness and a feel- 
ing of muscular quivering." 15 Or, as I've heard 



13. Slcdmun's Meiticnl Dictionary, 21st edition (Balti- 
more: Williams & Wilkins. 1966), p. 43. 



it described, "there's a machine in my stomach 
that won't stop." In other words, you become 
a perpetual-motion machine that never docs 
anything productive except a very fucked-up 
fox trot. This kind of strange behavior is 
sometimes called "psychotic agitation," and 
is often considered another indication of the 
true illness of the person, whereas in reality it 
is caused by the drug being used to "treat" the 
alleged illness. It may show up any time dur- 
ing the first month of drug-taking, and 
occasionally later. 

Last but not least is Parkinsonism, the 
most common of these muscular side-effects. 
This is the "as-if-you-had-Parkinson's-disease- 
space." Parkinson's disease used to be called 
"paralysis agitans" because of the semi- 
paralyzed yet agitated human being it created. 
This disease is pitiful because the person loses 
all the spontaneity and emotionality that 
make humans so incredibly human. In this 
Parkinson's space a person assumes a stooped, 
head-and-shouldcrs-lcaning-forward posture 
( the withered old person's look ) . and all the 
muscles move slowly and stiffly. The victim 
has an emotionless facial expression, a con- 
stant shaking (tremulousness) of the hands 
and feet, and a shuffling stcp-and-fctch-it 
walk. The fingers may end up like Humphrey 
Bogart's in the Caine Mutiny, but with imag- 
inary steel balls (called pin rolling). It's as if 
you were dipped in wax and made into a 
zoomorphic candle. 

Anti-Parkinsonian Drugs The drugs to 
counter the "madness!" The question of how 
to treat the muscular side-effects created by 
the "anti-psychotic" drugs is filled with the 
irony and paradox of the drugs themselves. 
The muscular side-effects will disappear if the 
anti-psychotic drugs are stopped. However, if 
a person has a muscle spasm ( dystonia ) , the 
spasm must be treated immediately by a shot 
of an anti-Parkinsonian drug ( such as Artanc, 
Cogcntin, or Akineton ) even if the anti- 
psychotic drug is stopped because the reaction 
is so painful and frightening. Anti-Parkin- 
sonian drugs relieve most of the muscular 



82 



1 18 MADNESS NETWORK NEWS 



sidc-cffccts immediately. Akathesia is the 
exception; it is much more difficult to treat. 

There was a time (and perhaps this is 
still true) when all good psychiatrists in train- 
ing were instructed to guard against muscular 
side-effects by automatically placing all 
"patients" on anti-psychotic drugs on an anti- 
parkinsonian drug as well. But "only" ten to 
twenty percent of people taking anti-psychotic 
drugs have a reaction severe enough to require 
an anti-Parkinsonian drug, and most of these 
severe reactions occur within the first few 
days or weeks of anti-psychotic drug treat- 
ment. 

The anti-Parkinsonian drugs — the 
antidotes — have their own undesirable side- 
effects. These are similar to the fio/i-muscular 
sidc-cffccts of the anti-psychotic drugs: dry 
mouth, blurred vision, nausea, constipation, 
vomiting, dizziness, difficulty urinating, 
numbness of the fingers, listlessness, depres- 
sion and occasional allergic reactions such as 
skin rashes. This is a real Catch-22; choose 
between the side-effects of the anti-psychotic 
drug and those of the anti-Parkinsonian. In 
other words, choose your poison. 

There is no "good" solution to this prob- 
lem. If you routinely give the anti-Parkin- 
sonian drugs you subject many people who 
don't need them to their undesirable side- 
effects. And if you don't give them routinely, 
ten to twenty percent of the people taking 
anti-psychotic drugs will go through some 
very frightening and painful experiences. To 
complicate matters even further, many people 
have the muscular reactions even when they 
have been given anti-Parkinsonian drugs. 
Even so, at the very least pushers of the anti- ' 
Parkinsonians ought to bear in mind that 
most of the muscle reactions, particularly the 
most horrible, take place within the first forty 
days of anti-psychotic drug taking, so very 
few people need to take an anti-Parkinsonian 
drug after that time. But I've seen people who 
had been taking anti-Parkinsonian drugs for 
years because the prescribing doctors had 
been careless, neglectful, and/or rigid and 
over-conservative drug pushers. 



Tardive Dyskinesia, or What Happened 
to My Brain? The second type of muscular 
side-effect is a permanent condition called 
Tardive Dyskinesia (T.D.) It occurs after a 
person has been taking an anti-psychotic drug 
for several years, although no one knows 
exactly how long it takes to occur, since every 
individual reacts differently to drugs. 

Tardive Dyskinsia was first "discovered" 
in elderly people in the back wards of state 
hospitals. This is what it docs to people: 



". . . twenty to twenty-five percent of 
people who have been given anti-psychotic 
drugs become afflicted with Tardive 

Dyskenisia." 

Tardive Dyskinesia is a central nervous 
system disorder, perhaps with irreversible 
effects. Its manifestations include involuntary 
movements especially affecting the lips and 
tongue, hands and fingers, and body posture. 
Consequently, speech may be seriously 
affected, the face may become distorted and 
subject to uncontrolled expressions, and sus- 
tained normal posture may become impossible 
. . . the dysfunction is twofold: neurological 
and interpersonal." 

Tardive Dyskinesia consists of slow 
rhythmical movements in the region of the 
mouth with protrusions of the tongue, smack- 
ing of the lips, blowing of the cheeks and side- 
to-side movements of the chin as well as other 
bizarre muscular activity. If any of these 
muscle problems start, all anti-psychotic drugs 
should be stopped, immediately." 
The condition lasts even after the victim is 
taken off the anti-psychotic drug. Equally 
horrifying is the rate of occurrence. Henry 
Lennard, a medical sociologist, has docu- 
mented and described the abuse of so-called 



14. Lennard and Bernslein, p. 28. 

1 5. George Crane. "Clinical Psychopharm.-icolopy in ill 
20th Year." Science, vol. 181. no. 4095 (July 13, 1973). 

p. 127. 



83 



the c:uki; 



119 



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tranquilizers by the psychiatric system. He 
reports that twenty to twenty-five percent of 
people who have been given anti-psychotic 
drugs become alllictcd with Tardive Dyski- 
nesia. European investigators report a five to 
twenty percent incidence rate of T.D. among 
users. Lcnnard estimates that anyone taking 
anti-psychotic drugs (for example Thorazine) 
at a daily dose of 300 milligrams — a moderate 
dose — for over two years may develop T.D. 
Thus a person who takes these drugs at mod- 
erate to high doses (no one knows for sure 
about low doses) for several years plays a 
version of Russian roulette. The psychiatrist 
or other pill-pusher never has the gun pointed 
at his/her own head, but merely loads it and 
gives it to you. Wanna take a chance? 

A side-note about T.D. is that it was first 
recognized in the early sixties, but psychiatric 
power potentates/drug dictators ignored it for 
as long as they could. Not until 1 972, when 
legal action was taken against drug companies 
on behalf of a "patient" with T.D. did the 
system publicly admit to the existence of the 
condition. Even now the psychiatric system 
wears its drug-covered glasses, and many 
psychiatric prisoners continue to face the risk 
of T.D. because psychiatrists refuse to take 
the necessary steps to prevent it. It doesn't 
lake a genius to guard against T.D. : ( 1 ) slop 
giving anti-psychotic drugs temporarily for 
several months— that is, prescribe a "vaca- 
tion" from the drugs; or (2) lower the dosage 
of the drug; or ( 3 ) permanently discontinue 
anti-psychotic drugs. Certainly a relapse into 
humanness is safer than the risk of permanent 
brain damage. 

Drug companies have been very resistant 
to even accepting the term Tardive Dyski- 
nesia, let alone using it in the brochures 
describing their drugs .Acknowledging the 
danger of T.D. inherent in the drugs wouldn't 
do much for sales! And the F.D.A., a govern- 
mental agency whose sole function is sup- 
posedly to protect consumers, has taken a 
dangerously long time in doing something 
effective to warn physicians about this condi- 
tion. The F.D.A. has also shown a reluctance 



to force the drug companies to openly accept 
responsibility for the fact that T.D. is caused 
by their drugs, and to warn consumers about 
it in drug ads, brochures, the P.D.R.' 6 and 
other drug information sources. 

In April of 1 973 a special editorial 
finally appeared in Archives of General 
Psychiatry, which spilled the beans so to 
speak and laid out the present psychiatric 
party line about Tardive Dyskinesia. Note 
that this article appeared almost fifteen years 
after T.D. was first recognized, and six to 
eight years after it became obvious what T.D. 
was all about. It's about time that all the 
truth came out. about this very serious result 
of anti-psychotic drug use. 

Tardive Dyskinesia has some unusual 
characteristics, and a controversy has arisen 
as to how to deal with this "syndrome" once 
it appears. As I said, it usually takes several 
years for T.D. to appear, and it often appears 
after the drugs arc stopped. At this point, one 
is faced with the choice between ( 1 ) not 




16. I'.D.R. is Ihc Physicians Desk Reference. This is ihe 
bible used by Ml physicians in prcscribinp drups. The I'.D.R. 
is manufactured wilh drup-company money, ihus insuring 
biased information as the basis for drup prescribing by 
physicians. 



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84 



120 MADNESS NETVC'OHK NEWS 



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giving any more such drugs, and accepting the 
fact thai permanent brain damage has been 
created for which there is presently no treat- 
ment, or (2) putting the person back on these 
drugs, which may reduce the intensity of T.D., 
but which will probably also create more 
brain damage. It's a fine kettle of fish, and to 
me the obvious answer is to not use these 
damaging dfugs in the first place and to 
develop human alternatives to drugs. At the 
very least stop all such drugs if there is any 
question about the possibility of T.D. 

Stopping the drugs is in itself a test for 
T.D., because quite often the symptoms of 
T.D. get worse after the drugs are stopped. It 
is important to note that if the dosage of the 
drugs is increased, existing T.D. may be 
masked; the increased dosage can reduce the 
intensity of T.D. symptoms or make them 
disappear altogether. This is very dangerous 
because by increasing the dose you arc creat- 
ing more brain damage even though it will not 
show up until sometime in the future (months, 
or even years). 

There arc several different reasons — 
psychological, neurological, and pharma- 
cological, why a person might develop some 
abnormal muscle movement. But if a person 
on anti-psychotic drugs starts to experience 
abnormal mouth or eye movements, facial 
tics, chewing movements, sucking movements, 
rocking or swaying movements of the body, 
restless movements of the arms or legs, fine 
uncontrolled movements of the tongue, then 
it is urgent that the possibility of Tardive 
Dyskinesia be checked out. 

Psychiatrists arc still in the dark about 
just what it takes to cause T.D. But remember, 
it's not their brains that get damaged, it's 
yours if you choose to take such drugs and 
risk T.D. A word to the wise is sufficient. 

In the End 

Quite often people taking anti-psychotic 
drugs don't realize that the side-cfTccts arc 
caused by the drugs. They think that the 
unusual things happening to their bodies arc 
just part of their crazincss. The reluctance of 



psychiatrists to freely volunteer information 
and most people's lack of initiative in tracking 
down this information for themselves arc 
both to blame. If you are on anti-psychotic 
drugs and your body isn't working or feeling 
right, ask questions, describe what's happen- 
ing and find out if it's you or the drug. And 
consider stopping the drug altogether. 

Some psychiatrists go so far as to say 
that it's good for a person to experience some 
of these side-cfi'ects (other than T.D.), be- 
cause they convince the "patient" that the 
drugs arc powerful and "working" to control 
his/her crazincss. I believe it's a source of 
confusion and distress for one's body not to 
work right. It's something to be avoided, not 
created. 

The medical rationale is that unpleas- 
ant side-effects arc a small price to pay for 
chemical mind- and behavior-control. I think 
it's up to the individual into whose body the 
drug is going to decide that, not the person 
giving the drug. If you have decided to take 
anti-psychotic drugs and are experiencing 
unpleasant sidc-cffccis. then reevaluate your 
decision. If it was someone else's decision, 
make your own. You can decide to discon- 
tinue the drug. If you decide to remain on the 
drug, be aware that you can ( 1 ) request and/ 
or demand a lower dosage; (2) request an 
cvery-othcr-day schedule; (3) request a drug- 
free period (a drug holiday) of weeks or 
months; (4) request another drug (though 
you may merely end up with other side 
effects). 

Remember, "drugs arc prescribed to 
solve all types of management problems, and 
failure to achieve the desired results causes 
an escalation of dosage, changes of drugs, and 
poly-pharmacy (use of many drugs)." Drugs 
arc tools, and whether or not psychiatrists 
help or hurt a person with these tools is up to 
each individual doing the prescribing and 
each individual receiving the drug. But the 
"tool or be tooled" problem is subtle. It is 
important that you understand the medical 



17. Crane, p. 125. 



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85 



Tim CURI 



121 



JBOatona liT '" ' - - -- 



rationale of drug-giving as you read this 
article so that you will recognize the logic 
before (or the next time) you become victim- 
ized by it. In brief, this is how the cycle — 
like a dog chasing its tail or a snake cnling 
itself inside out — almost invariably works: 

A person experiencing "psychosis"/ 
"madness" is labeled "untouchable" and 
"sick" and is placed on anti-psychotic drugs 
which can produce mental and physical 
changes in the individual which themselves 
are labeled untouchable and sick which pro- 
moles "crazy"/"psycholie" interactions 
between the labeled and the labclers which 
promotes more anti-psychotic drugs which 
causes more labeling which promotes 
continual behavior that can be labeled 
"psycholic"/"mad"/"erazy"/"anli-social" 
which reinforces the need (a created need) 
for anti-psychotic drugs which creates more 
"crazy"/"psycholic" behavior which rein- 
forces the untouchable label which promotes 
even more "crazy "/"psychotic" interactions 
... ad nausaum. 

Too light to walk. 

Too tight to talk. 

My muscles seem lost, 

My mind' sail a balk. 

In the end . . . it's up to you. 
Replace pills with people. 

[Appendix] 

For Schizophrenic Patients, a Way Out . . , 
Controlled Drug Delivery. 

Prolixin is the 1 984 mind-control drug. 
It is an anti-psychotic mind-crusher that is 
given as an injection once every two lo three 
weeks. Once the injection is given the person 
getting this mental glue has absolutely no way 
of doing anything about this drug; there is no 
way of controlling the strength of the drug 
once the shot is given. Think about this: 
After an injection of Prolixin, the next two 
weeks of your life will be controlled by other 
people (psychiatrists, conservators, nurses, 
psychiatric technicians, etc.) by means of 



"Today Prolixin injections arc being ever 
more widely used. This drug solves the 
problem of getting psychiatric patients/ 
prisoners to take their pills." 



a drug which has been deposited in your ass 
and which will slowly seep into your blood 
system from your ass-muscle day . . . after day, 
after day 

The pictures in Prolixin ads arc designed 
to totally invalidate and put down any 
"paticnlV'/person's independent thinking or 
independent action in ending a dependency 
on drugs. ( Most Americans say they are 
opposed to drug dependency. ) They sup- 
posedly portray the four common reasons for 
rcadmission to mental hospitals. Of course, 
these arc empty advertising lies. 

Within the system a person's decision to 
stop taking dangerous drugs is seen as a 
problem. Such a person is considered misled 
or weakened. A person who decides to stop 
taking drugs that produce strong negative 
bodily reactions, including permanent brain 
damage called Tardive Dyskinesia, is con- 
sidered "mentally unhealthy." 

Today Prolixin injections arc being ever 
more widely used. This drug solves the 
problem of getting psychiatric patients/ 
prisoners to take their pills, it's easy to give, 
saves times, and insures complete control. 
More and more community mental-health 
centers arc starting Prolixin clinics. Squibb is 
making a fortune off this drug and recently 
introduced a new version of it because their 
patents ran out on the old form. They know 
they have got a money winner and want to 
get all they can from it. Prolixin is the 1 984 
mind-control tool, here today! (gone tomor- 
row, I hope!). 







86 

Mr. Hudson. One thing we do is talk to a lot of people who have been 
locked up and victimized, and collect their testimony and disseminate 
this information to the people in different ways. And here I have ap- 
proximately, I believe about 30 statements of people, which is very 
powerful, as well as some other literature. 

We publish a lot of literature, as I mentioned, the Madness Network 
News. We speak anywhere and everywhere that we can, including in- 
side psychiatric institutions and halfway houses, on radio and TV. 
We conduct demonstrations now and then. And through a closely 
related organization, we work on legislation in Sacramento, though 
that is the NAPA Legal Action Committee, and not NAPA. 

Senator Bayh. Thank you very much. We appreciate your state- 
ments of your experiences. We would appreciate, frankly, any other 
examples of this kind of abuse that you might find from pursuing this 
particular mission that you are now on. If you would call them to 
our attention, we would appreciate it. 

Mr. Hudson. I will be sure to do that. 

Senator Bayh. Ms. Chamberlin, we appreciate your being with us 
this morning. 

STATEMENT OF JUDI CHAMBERLIN, BELLINGHAM, WASH. 

Ms. Chamberlin. Thank you. 

My name is J'tidi Chamberlin. I am an ex-mental patient, and I am 
a long time activist in the mental patients liberation movement. 

Mental patients are an oppressed group, who are powerless. We are 
alone, and we are discredited, because we have been defined as mentally 
ill, and therefore, anything can be done to us in the name of treatment. 

Our individual protests are used by our psychiatrists- jailers as 
justifications for further so-called treatment. It is only through col- 
lective protest, through the mental patients liberation movement, that 
we are bringing to public awareness the abuses that go on in the name 
of mental health. 

My own personal experiences with psychiatric drugs involved Tho- 
razine, Stelazine, Mellaril, Elavil, Cogentin, Doriden, and Chloral 
Hydrate. I would like to focus on the experiences I had with Thora- 
zine, because that was the drug I took the most of, and it is also the 
most commonly used psychiatric drug. 

I was first administered Thorazine, in conjunction with Stelazine, 
on an outpatient basis, before I had ever been hospitalized. The only 
information I was given was the name of the drug. I was not told 
the possible side effects or dangers, or asked whether I wished to take 
the risks involved. I was, at that time, a private patient of a psy- 
chiatrist, and this supposedly is the situation in which one is least 
subject to abuse. I was not, at that time, institutionalized. I was seeing 
this psychiatrist privately. I was paying for him. 

He was expensive. He had an office in the fancy part of town, and 
that is when I started taking Thorazine. 

Later on, when I was hospitalized, I was given Thorazine and 
Stelazine again, with the same lack of information as to possible side 
effects. When I was initially given Thorazine I received no medical ex- 
amination. In the hospital, I was given a cursory physical examination. 

What I would like to do is quote some of the information listed 
under the side effects for Thorazine in the PDR, the Physicians' Desk 



87 

Reference, which is a book that lists all of the drugs manufactured in 
the United States, and this is the information that the drug companies 
themselves put out about the drugs that they give, so they put it in 
the most favorable light. And the section on Thorazine runs for about 
two pages, three columns on a page, very fine print, and it is mostly 
various side effects. 

SIDE EFFECTS CITED AS "UNCOOPERATIVE BEHAVIOR" 

I would like to describe some of the side effects as I actually felt 
them. According to the PDR, drowsiness, usually mild to moderate, 
may occur. My experience was that it did occur with such intensity 
that I began to take a daily midday nap. Despite the fact that this 
drowsiness was a drug side effect, I was forbidden to take naps by the 
hospital personnel. Later, the fact that I took naps rather than re- 
maining in the dayroom was cited as an example of my uncooperative 
behavior. 

Senator Bayh. How did they treat you? What did they do to you 
to keep you from taking naps ? . 

Ms. Chamberlin. They would come in and tell me to go sit in the 
dayroom. 

Senator Bayh. Let me understand this. The normal reaction to tak- 
ing this drug is to take a nap ? 

Ms. Chamberlin. It is to get drowsy. 

Senator Bayh. To become drowsy, all right. They gave it to you 
and then took steps to keep you from taking a nap ; but, then wrote 
in your record that the refusal to take a nap was 

Ms. Chamberlin. That my wanting to take naps was showing I was 
uncooperative, because supposedly being in the dayroom would be 
therapeutic. The dayroom is where you sit around and watch TV, and 
things like that. 

Senator Bayh. Thank you. 

Ms. Chamberlin. This thing about uncooperative behavior came 
up when I went back to the hospital and asked to be readmitted. And 
when Janet was saying about how they managed to make you feel 
dependent on them, that you have all of these very devastating effects, 
and yet you feel you need more of this kind of treatment— it was not 
until later on, when my mind got clearer about what had been going 
on that I stopped thinking that way, but at this time, I went back to 
the hospital, and I said, I want to come back, and they said they could 
not have me back. And one of the things they said was, while you 
were here, you were very uncooperative, And I had thought I had been 
extremely cooperative. This really surprised me. And they did not 
take me back. 

This was in a psychiatric ward of a general hospital. They did not 
take me back. But* they said I was too sick to go home, so they sent 
me to Bellevue, which is a public hospital in New York City. Alto- 
gether, I was in six hospitals, public and private. ... 

Then the PDR goes on to say about drowsiness that if it is trouble- 
some, lower the dosage or administer small amounts of dextroampheta- 
mine, and, of course, the brand name of dextroamphetamine is Dexa- 
drine. It is kind of speed, so they give you Thorazine, which slows you 
down, and they give you something else to speed you up. And ot 
course, Dexadrine is addictive, and it has many side effects, itseli. 



88 

DRUG SIDE EFFECTS LEARNED FROM PATIENTS 

Then the PDR lists, under central nervous system effects, neuro- 
muscular, or extrapyramidal reactions, closely resembling Parkin- 
sonism and motor restlessness. When I began to find myself trembling 
uncontrollably — not knowing it was a drug reaction— I became very 
frightened. It was from other patients that I learned this was a drug 
side effect. This was a common way of gaining useful information 
that was not given by staff members. 

The use of Cogentin to control the tremor brings its own set of 
side effects, including, and this is a quote from the PDR listing of 
Cogentin, "intensification of mental symptoms, mental confusion and 
excitement, visual hallucinations, and dry mouth." The PDR states 
that psychotic symptoms and catatonic-like states can be caused by 
Thorazine. Since the drug is being administered supposedly to con- 
trol these conditions, a vicious circle is created. 

My frequent attempts to convince my doctors that while taking 
Thorazine, I felt, in addition to my original depression, intense fear 
and anxiety, was met by only one response, increased dosages of Thora- 
zine. During the periods when I was not taking Thorazine, the fear 
and anxiety decreased. Since I took the drug on different occasions 
several months apart, it became clear to me, although I was unable 
to convince anyone else, that these feelings were drug related. The 
anxiety, jitterness, and fear, in addition to all of the other drug- 
related and nondrug-related sensations that I was experiencing at that 
period in my life, made it impossible for me to do anything to im- 
prove my life situation. 

My attempts to do something positive for my life did not happen 
until a year later, when I was not taking any drugs, and when I 
was voluntarily seeing a nonmedical therapist, who was a psychologist. 
And we did not use any drugs, and my head was a lot clearer, and I 
began to be able to make some decisions relating to what I wanted 
to do with my life. 

During the period that I was hospitalized, all of my behavior was 
attributed by staff to my illness. Since I was then in a highly vul- 
nerable emotional state, I half believed that perhaps I was as crazy 
as I was continually being told I was. The lack of information as to 
drug side effects contributed to this feeling, since I was discovering 
that my body was less and less under my voluntary control. The re- 
petitive pacing which I found myself doing and saw so many other 
people doing made me feel at least some of the time that we all be- 
longed in a mental hospital. 

Thorazine's side effects made us look just like the stereotypes of 
mental patients. Now, with the advantage of having full information 
about drug side effects, I can appreciate that manv of the things that 
I experienced were caused by the drugs that I was being given, as 
well as the environment of the mental hospital. 

Mental hospitals are very frightening and boring places, and when 
you are in a place where there is nothing much to do, I think anyone 
would react pretty much the same way. That is used to convince both 
you and other people that you are nuts, because vou are doin<x all the 
things that people think of nutty people doin.q:, like pacing the floors. 
And if you are locked up in a little room, I think most people would 



89 

react to it by pounding on the door, and of course, that is also con- 
sidered a good reason why you are locked up in the little room. This 
happens pretty often to people in mental hospitals. If you object to 
something that is being clone, if you do not want to take your medica- 
tion, or you have had an argument with somebody, they take you and 
lock you in a little bare room, and I think that the normal reaction to 
being locked in a bare room is to ask to get out of it. 



PREPARED STATEMENT OF JUDI CHAMBERLIX 

I was first administered Thorazine (in conjunction with Stelazine) on an 
out-patient basis, before I had ever been hospitalized. The only information I 
was given was the name of the drug ; I was not told of possible side effects or 
dangers, or asked whether I wished to take the risks involved. I was at that 
time the private patient of a psychiatrist (supposedly the situation in which 
one is least subject to abuse). Later, when I was hospitalized, I was given 
Thorazine (and Stelazine) again, with the same lack of information as to 
possible side effects. When I was initially given Thorazine, I received no medical 
examination; in the hospital, I was given a cursory physical exam. I would 
like to quote some of the information listed in the Physician's Desk Reference 
(PDR) for Thorazine, and describe how some of the listed side effects actu- 
ally felt. 

According to the PDR, "drowsiness, usually mild to moderate, may occur." 
My experience was that it did occur, with such intensity that I began to take a 
daily mid-day nap. Despite the fact that this dowsiness was a drug side effect, 
I was forbidden to take naps by the hospital personnel. Later, the fact that I 
took naps rather than remaining in the day room was cited as an example of 
my "uncooperative behavior." The PDR continues to say that if drowsiness 
"is troublesome, lower dosage or administer small amounts of dextroamphet- 
amine." This is of course. Dexedrine. an addictive drug with a long list of side 
effects of its own. 

Under CNS (central nervous system) effects, the PDR goes oh to discuss 
"neuromuscular (extrapyramidal) reactions, closely resembling parkinsonism, 
and motor restlessness . . ." When I began to find myself trembling uncontrol- 
lably, not knowing that it was a drug reaction, I became very frightened. It was 
from other patients that I learned that, this was a drug side effect. (This was a 
common way of gaining useful information that was not given by staff mem- 
bers. ) The use of Cogentin to control the tremor brings its own set of side effects 
(including "intensification of mental symptoms, mental confusion and excite- 
ment, visual hallucinations, and dry mouth" according to the PDR listing). 

The PDR states that "psychotic symptoms and catatonic-like states" can be 
caused by Thorazine. Since the drug is being administered supposedly to control 
these conditions, a vicious circle is created. My frequent attempts to convince 
my doctors that, while taking Thorazine, I felt, in addition to my original 
depression, intense fear and anxiety, was met by only one response — increased 
doses of Thorazine. During the periods when I was not taking Thorazine, the 
fear and anxiety decreased. Since I took the drug on different occasions several 
months apart, it became clear to me (although I was unable to convince anyone 
else) that these feelings were drug related. The anxiety, jitteriness. and fear — 
in addition to all the other drug-related and non-drug-related sensations I was 
experiencing at that period of my life — made it impossible for me to make any 
attempts to improve my life situation. I could not do this until a year later, 
when I was not taking any drugs, and had the support of a non-medical thera- 
pist, a psychologist. 

During the period I was hospitalized, all of my behavior was attributed by 
staff to my "illness." Since I was then in a highly vulnerable emotional state, 
I half-believed that perhaps I was as "crazy" as I was constantly being told I 
was. The lack of information as to drug side effects contributed to this feeling, 
since I was discovering that my body was less and less under my voluntary 
control. The repetitive pacing which I found myself doing and saw so many other 
people doing made me feel (at least sometimes) that we all belonged in a mental 
hospital. Thorazine side effects made up look just like the stereotype of mental 
patients. Now, with the advantage of having full information about drug side 
effects, I can appreciate that many of the things I experienced were caused by 



90 

the drugs I was being given, as well as the environment of the mental hospital 
itself. 

"Allergic reactions of a mild urticarial type or photosensitivity are seen." 
What this means in practice is that on summer days, when there was an oppor- 
tunity to leave the ward and sit in the warm sunshine, many of us had to remain 
indoors. I discovered this side effect after a day in the sunshine, when my skin 
started to itch painfully. I was not warned in advance that this would happen, 
but left to discover it painfully for myself. Nursing personnel are forwarned of 
allergic skin reaction which they may experience ; the PDR states "contact 
dermatitis has been reported . . . , accordingly, the use of rubber gloves when 
administering 'Thorazine' liquid or injectable is recommended." 

Thorazine liquid concentrate, one of the dosage forms in which Thorazine is 
available, not only causes contact dermatitis, it causes an intense burning sensa- 
tion on anything it touches. Although concentrate is usually administered 
diluted in juice, my one experience with it was somewhat different. I was given 
a small paper cup filled with liquid, and told to drink it. When I asked what it 
was, I was told only "it's concentrate, drink it." I sipped it like it was juice, at 
which point my lips, tongue and throat started to burn so intensely I thought 
they were being dissolved by the liquid. About half a dozen attendants stood 
by watching, knowing looks on their faces, as I stumbled about, trying to catch 
my breath and my balance, tears running from my eyes. I was bent over nearly 
double. After five minutes or so, when I was standing more or less normally, the 
small audience melted away. This took place on my first day in a state hospital. 
After this one occasion, I was always administered Thorazine in pill form. 

Another listed side effect is "occasional dry mouth," an understatement for 
the cottony feeling and thick tongue that made talking and swallowing diffi- 
cult. Everyone I knew who took Thorazine experienced this sensation. Dry 
mouth is also a side effect of Cogentin, the drug administered to counter the 
tremor caused by Thorazine. During one period of hospitalization, I was kept in 
a locked ward, where we were locked into the dayroom nearly all day, except 
for meals. No water was available in the locked dayroom. 

Constipation, another listed side effect, together with the starchy hospital 
diet, lacking in fresh fruits and vegetables, made the constant administration of 
laxatives a regular part of hospital routine. Thorazine is also said to cause 
"increases in appetite and weight" and "amenorrhea" (cessation of menstrua- 
tion) — both of which occurred and caused me a great deal of anxiety and 
discomfort. 

I have excerpted from the PDR only those side effects which I know I 
experienced. Many of the other listed side effects could be detected only by skilled 
medical examination : "fine particulate matter in the lens and cornea — star- 
shaped opacities in the lens . . . EKG changes — jaundice — cerebral edema . . . 
abnormality of the crebrospinal fluid" and so forth for several pages of fine 
print. Perhaps the most devastating side effect is tardive dyskinesia, an irreversi- 
ble syndrome involving "rhythmical involuntary movements of the tongue, face, 
mouth or jaw (e.g., protrusion of tongue, puffing of cheeks, puckering of mouth, 
chewing movements). Sometimes these may be accompanied by involuntary 
movements of extremities. There is no known effective treatment for tardive 
dyskinesia." This syndrome occurs in chronic patients (more commonly in 
women) who have been institutionalized and maintained on high doses of 
Thorazine for many years — just the people one would most expect to be "crazy 
looking." These repetitive, unpleasant-looking movements are not "symptoms" of 
"mental illness," they are the direct result of long-term administration of 
Thorazine. 

Since most people in mental hospitals are there against their wills (even many 
so-called voluntary patients, who are threatened with commitment unless they 
enter "voluntarily"), it is important to note that the PDR recommends that 
dosage levels of Thorazine be increased "until patient becomes calm and coopera- 
tive." What this means in practice is that people who object to their confinement 
and make their objections known to hospital staff are drugged to the point that 
they can no longer protest their own imprisonment. Patients who ask to be 
released and who state that they are not sick are often thought to be displaying 
"symptoms" of "mental illness." The PDR states that Thorazine dosage should 
be increased "until symptoms are controlled." Since everything a mental patient 
does while hospitalized can be called a symptom (as every mental patient knows, 
and as was shown by the Rosenhan study), this statement is a license to admin- 
ister Thorazine until the patient becomes a walking zombie. 



91 

Although the PDR states that "Thorazine is not known to cause psychic 
dependence and does not produce tolerance or addiction," it goes on to say that 
"following abrupt withdrawal of high-dose therapy, some symptoms resembling 
those of physical dependence such as gastritis, nausea and vomiting, dizziness 
and tremulousness" can occur. Gradual reduction of dosage rather than abrupt 
withdrawal is suggested. Common sense would seem to dictate that when a drug 
causes such withdrawal symptoms, it is an additive drug, no matter what it is 
called. I can state that, following abrupt withdrawal of Thorazine in a hospital, 
I experienced hot and cold flashes, nausea, stomach cramps, and the excruciating 
feeling of something crawling under the flesh. I was not warned by staff members 
that I would experience withdrawal symptoms, and while I was experiencing 
them, I was not told what they were. It was only from another patient that I 
learned what was happening, and that knowledge, although it did nothing to 
relieve the pain, at least reassured me that it had a cause, and it would end. 

I know that what happened to me is not an isolated incident. I know many 
ex-mental patients, who have had similar (or far worse) experiences. While 
psychiatrists may speak of the "revolution" in "mental health care" that the 
so-called "tranquilizers" have brought about, it is no less dehumanizing to be 
controlled by a chemical than by a straitjacket. 



Senator Bayii. May I ask you how old you are ? 

Ms. Chamberlin. I am 30. This all happened when I was 21. 

Senator Bayh. You do not look 30; I mean that in a complimentary 
way. 

Now this happened when you were 21. How did you get out of the 
grasp of the mental institution syndrome ? 

DECISION TO BECOME RELEASED 

Ms. Chamberlin. I was in six different hospitals during this period. 
I was in four of them as a legally voluntary patient, although at 
least one of them I went into under extreme duress, even though 
legally I w T as considered a voluntary patient. And I was in two of 
them involuntarily. And the last hospital I was in was a State hos- 
pital. I was in there involuntarily, and had a similar experience to 
Wade's, just deciding that if I w T as ever going to do anything about 
my life, step No. 1 was to get myself out of this place. 

So I made a decision, and it was a very conscious decision, in spite 
of the fact that supposedly I was — I am trying to remember what 
my diagnosis was at that point, chronic or catatonic schizophrenic, 
I think I w r as diagnosed at that point. Even though I supposedly 
had this incapacitating mental illness, I made a very conscious deci- 
sion that I was going to cooperate with everything that was asked 
of me, and I was not going to give them any cause to have any rea- 
son to say I was uncooperative, because I had already had this experi- 
ence in another hospital of being called uncooperative because I took 
naps. 

The first day I w r as in the State hospital, which was an incredibly 
bleak environment, I was very frightened, I was very upset. I did not 
know what w T as going to happen to me, and I was given an old, shape- 
less dress to wear* My own clothes were taken away. So I looked just 
like pictures I had seen of people in mental hospitals. I was sitting 
on a wooden bench in an old, shapeless dress, and I reacted to this 
fear by drawing up my knees and putting my head down, and I started 
to cry. And another patient leaned over and whispered to me, she said, 
"do not do that, they will think you are depressed." And I realized 



92 

that in this context, being thought of as depressed would be very 
bad, so after that, I only cried very quietly in my own room, when 
the lights were out, when I was supposed to be sleeping. 

And I was in on a 60-day commitment, and after about most of that 
had passed — I guess about 6 weeks of that had passed — I was handed 
a paper saying I was no longer an involuntary patient; I was now a 
voluntary patient. At that point I sat down and wrote a 10-day letter, 
which the law required, that even as a voluntary patient, the law re- 
quired you had to give 10 days notice of wanting to leave. So I was 
discharged on my own request after that 10-day period. So I was there 
in the State hospital about 7 weeks. 

Senator Bayh. You were 21 then ? 

Ms. Chamberlin. Yes. 

Senator Bayh. So now, 9 years later, what have you done with your 
life ? What are you doing ? 

Ms. Chamberlin. For the last 4 years, I have spent almost all of 
my time involved in the mental patients liberation movement. I have 
been involved in it in many different parts of the country. I helped 
to organize the second National Conference on Human Rights and 
Psychiatric Oppression, which was held in Topeka, Kans. in 1974. 
I fust recently attended the third annual conference which was held 
in San Francisco in July. 

[Exhibit No. 8] 

[From the State Journal, Jan. 15, 1976] 

MENTAL CLAN ANGRY— THEY WANT LIB, TOO 

(By Judi Chamberlin) 

You already know about women's lib, gay lib, kid's lib. Now let me introduce 
you to a whole new lib. 

Past and present mental patients are angry about the way they are being 
treated — both in and out of institutions. We are tired of being imprisoned and 
drugged against our will, just as we are tired of being tormented by the ignorant 
once we return to our homes. So some of us, myself included, have joined to- 
gether to form what — for lack of a better term — we call mental patient's libera- 
tion groups. 

The message of "mental patients' lib" is a simple one: Despite the assurances 
of psychiatrists to the contrary, mental institutions in this country do not 
routinely fulfill their assignment : to deliver legitimate medical assistance to 
people who are sick, much as medical hospitals are supposed to do. 

Instead, mental institutions often serve as repositories for the unwanted in our 
society. They are more like prisons than hospitals. Of all those detained in such 
institutions, few are seriously ill. Most are individuals who society has deter- 
mined should be controlled, usually because their behavior is, for one reason or 
another, considered different from "normal." 

The prison trappings are inescapable, save at some new institutions which are 
run on an "open" basis. Many mental hospitals still have iron doors with locks— 
which are used — as well as windowless cells for solitary confinement. 

Beyond enforced incarceration, there is another and perhaps greater evil. This 
is the use of drugs — which has all but replaced the infamous strait/jacket as a 
means of controlling patients. It may sound like a step forward, but in practice 
is not. Indeed, the use of potent mind-changing drugs has become so indiscrimi- 
nate in recent years as to be almost criminal. It is unlawful drilg abuse. 

That is exactly what a number of former mental patients recently told a 
Senate judicial subcommittee investigating juvenile and adult institutions. I 
was one of the witnesses. 

We told of horrifying experiences we had had after being administered mas- 
sive doses of phenothiazine tranquilizers, which, in some forms, linger in the 
brain for up to two weeks and can make the victim a virtual zombie. 



93 

It was clear from subsequent questioning that Sen. Birch Bayh, D., Ind., chair- 
man of the subcommitte, was alarmed by our reports, and so were his colleagues. 
We hope their shock will be translated into remedial legislation. 

But the American mental-health scandal goes beyond the use of mind-numbing 
chemicals. Once a person has been lebaled '•mentally ill," he or she can expect 
enormous and long-lasting consequences — medical, legal, social and not least of 
all, economic. Nine years have now passed since I was last released from a 
mental institution, and various forms of discrimination still haunt me. (I am 
not, for instance, allowed legal custody of my daughter from a former marriage). 

I believe all these injustices — the handling of patients as if they were convicts, 
the rampant misuse of drugs, the plight of former patients — have their genesis in 
the commitment process itself. Normally, when Americans need medical help, 
they go to a hospital — voluntarily. But someone believed to be mentally ill is 
usually "hospitalized" or "committed' because another party — the police or the 
family of the individual — finds certain behavior alarming. In most cases it is 
the psychiatrist, not the prospective patient, who makes the ultimate decision to 
institutionalize. 

However, the psychiatrist who commits does not act as an agent for that indi- 
vidual. Rather, he acts on behalf of those who seek to deprive the prospective 
patient of his liberty. 

Ms. Chamberlix. I am writing a book about the mental patients 
liberation movement, and I am trying to work wherever I can. Right 
now, I live in Washington State, where I am working with other ex- 
mental patients. Eight now, we are trying to set up a f reakout center, a 
place where people can come when they feel that their lives are in a 
state of crisis, which will not be run by medical people, but which will 
be run by people who have had similar experiences themselves, and 
which will provide a supportive atmosphere without any drugs being 
given, and without any formal psychotherapy being given, but just a 
lot of warmth and emotional support. And we are trying to get fund- 
ing for this. 

Senator Bayh. You live in Washington ? 

Ms. Chamberlix. Yes, Washington State. 

Senator Bayh. Do you have a family ? 

PSYCHIATRIC HISTORY RECORDS USED IX COURT CASE 

Ms. Chamberlix. No; I lost the custody of my child. I was mar- 
ried at the time I was in the mental hospital. I am divorced now. My 
husband and I had a child 2 years after I was discharged from the 
hospital. We separated 2y 2 years after that, and I lost custody of my 
child on the grounds that I was too mentally ill to be a fit mother, in 
spite of the fact that my psychiatric history ended 2 years before my 
child was born. All my hospital records were brought into court. The 
judge could see them. 

My ex-husband's lawyer could see them, and he made some very 
vicious comments to me, when he was cross-examining me, based on 
things that he read but that I was not allowed to see, because these 
w T ere my psychiatric records, and everybody else, it seemed like, could 
look at them and say terrible things about me, based on what they 
contained. 

Senator Bayh. Did you not have a lawyer at that time? 

Ms. Chamberlix. Yes; my lawyer saw them, and I saw a little bit 
of thorn. We were able to look at them for about a half an hour, and 
since there were records from six different hospitals, T was just able 
to kind of take a quick glance at them. That is the only time I have 

83^303 0—77 8 



94 

ever seen them. The only other access I have ever had to any part of 
my record was when I was in the State hospital. I was in the nurse's 
office, and she had a list posted of all patients, and I glanced at mine, 
and next to my name were two little words which I puzzled over for 
awhile and finally figured out what they meant. And what it said was 
sui/homi, and I thought about that for a little while, and I decided 
they had me listed as suicidal and homicidal. And I perhaps made a 
mild suicide attempt at one point, but I certainly do not know why 
they had me listed as homicidal. 

Senator Bayh. I assume that was during the period you were 
institutionalized ? 

Ms. Chamberlin. No; it was in one of the periods that I was out 
that I made this suicidal gesture, I guess it would be called. 
Senator Bayh. But it was prior to your final release ? 
Ms. Chamberlin. Yes; but I still do not know why they had me 
listed as homicidal, and I presume that is what it meant. I know 
I was in a very high security ward, where we were kept locked in a day- 
room from about 6 o'clock in the morning until 8 o'clock at night, ex- 
cept bathroom breaks and meals. 

Senator Bayh. This is not totally related ; but I must say, as a law- 
yer, I wonder about the lawyer that you had representing you in your 
child custody case. Did he ask questions about how this notation was on 
your record ? 

Ms. Chamberlin. No, that did not come up. 

Senator Bayh. Was this your lawyer, or was it a court-appointed 
lawyer? 

Ms. Chamberlin. No; this was my lawyer. The thing about the sui- 
cidal-homicidal thing was not mentioned by my husband's lawyer, so I 
guess my lawyer decided not to mention it either. But the thing was 
that the judge decided on the basis of the fact that I had six hospital 
records I was one of those crazy mental patients, and there was nothing 
that could be said to dissuade him from this. And in his opinion, it 
was written in such a way that he never quite came to grips witli the 
fact that the last I had ever been hospitalized was 2 years before my 
child was even born, because he said things about my illness affected 
my ability to care for her, which had never been mentioned in any 
testimony, which was totally his own creation. 

I will return to my statement. There are some more of these physical 
reactions that I experienced, and one of them is called in the PDR, 
allergic reactions of a mild urticarial type — that means itching of the 
skin or photosensitivity — are seen. And of course, mild — Janet de- 
scribed the sensation of feeling like things were crawling all over her, 
and that is certainly not a mild itching, and that is a very common 
experience. 

And what the photosensitivity means is that on summer days, when 
there is an opportunity to leave the ward and sit in the warm sunshine, 
many of us had to remain indoors. I discovered this side effect after 
a day in the sunshine, when my skin started to itch painfully. I was 
not warned in advance that this would happen, but left to discover it 
painfully for myself. 

STAFF PERSONNEL WARNED OF THORAZINE CONTACT 

The PDR does warn nursing personnel who handle Thorazine that 
contact dermatitis has been reported. Accordingly, the use of rubber 



95 

gloves when administering Thorazine liquid is recommended. If you 
are a nurse, you are warned not to let this thing touch your skin, but if 
you are a patient, you are not warned that if you go out in the sunshine, 
you are going to have the same skin reaction. 

Thorazine liquid concentrate, one of the dosage forms of Thorazine 
available, not only causes contact dermatitis, it causes an intense burn- 
ing sensation on anything it touches. Although the concentrate is 
usually administered diluted in juice, my one experience with it was 
somewhat different. This occurred on my first day in the State hospital, 
and I was given a small paper cup filled with a liquid, and I was told 
to drink it, and I said, what is it? And they said, it is concentrate; 
drink it. So I sipped it. I just picked it up and went like that. And 
apparently, if you throw it back real fast, you get a much milder reac- 
tion, but nobody told me to do that, so I just sipped it, and it began to 
feel that my lips, and my tongue, and my throat were burning so in- 
tensely that it felt like they were being dissolved. 

There were about half a dozen aides standing there watching. They 
knew exactly what was happening to me. I could tell by the expressions 
on their faces, and I was kind of bent over double, clutching myself. 
Tears were running down my face. I was trying to catch my breath. 
I was trying not to fall. Xobody stepped forward to help me. They just 
stood there, kind of in a circle around me, watching me. And after 
about 5 minutes, it began to wear off, and I began to straighten up, and 
then this little audience disappeared. 

And after that, I was always given pills, and it was very clear to 
me that this was a warning that if you do not take your pills, if you try 
to hold the pill in your mouth, or hold it in your hand, if you do not 
take your pills, you are going to be given this liquid again. 

Another listed side effect is occasional dry mouth, an understate- 
ment for the cottony feeling and thick tongue that made talking and 
swallowing difficult, Everyone I knew who took Thorazine experi- 
enced this sensation, so even though it is called occasional in the litera- 
ture, I think that is an understatement. 

Dry mouth is also a side effect of Cogentin, the drug administered 
to counter the tremor caused by Thorazine. During one period of 
hospitalization, I was kept in a locked ward, and we were kept in a 
locked dayroom on the ward. There was no water available in the 
dayroom, so even if the dry mouth can be relieved for a few minutes 
anyway by sipping some water, there was not any water to sip. 

Constipation is another listed side effect, and this, together with 
the starchy hospital diet, with no fresh fruits or vegetables, made the 
constant administration of laxatives a regular part of hospital routine. 

Thorazine is also said to cause increases in appetite and weight, and 
amenorrhea, which means a cessation of menstruation, both of which 
occurred, and both of which caused me a great deal of both anxiety 
and discomfort, and this was in addition to all of the other things I 
was experiencing at this time. I stopped menstruating for about 6 
months, altogether, and did not start again until after I had not taken 
Thorazine for awhile. 

I have excerpted from the PDR only those side effects which I know 
I experienced. I may have experienced other listed side effects which 
could only be detected by skilled medical examination. Some of these 
are fine, particulate matter in the lenses of the cornea, star-shaped 
opacities in the lens, so that is permanent eye damage; changes in 



96 

EKG; jaundice; cerebral edema, abnormality of the cerebral spinal 
fluid ; and this goes on and on. That is just a few of them. 

TARDIVE DYSKINESIA IRREVERSIBLE SIDE EFFECT 

And the most devastating side effect is tardive dyskinesia, an ir- 
reversible syndrome involving "rhythmical involuntary movements of 
the tongue, face, mouth or jaw, protrusion of the tongue, puckering 
of mouth, chewing movements. Sometimes these may be accompanied 
by involuntary movements of extremities. There is no known effective 
treatment for tardive dyskinesia," That whole thing is a quote from 
the PDR. 

This syndrome occurs in chronic patients, more commonly in women, 
who have been institutionalized and maintained on high doses of 
Thorazine for many years, just the people one would most expect 
to be crazy looking. These repetitive, unpleasant looking movements 
are not symptoms of so-called mental illness. They are the direct 
result of long-term administration of Thorazine. 

Since most people in mental hospitals are there against their wills, 
even many so-called voluntary patients, who are threatened with 
commitment unless they enter voluntarily, it is important to note 
that the PDR recommends that dosage levels of Thorazine be in- 
creased "until patient becomes calm and cooperative." What this 
means in practice is that people who object to their confinement and 
make their objections known to hospital staff are drugged to the point 
that they can no longer protest their own imprisonment, 

Patients who ask to be released and who state that they are not sick 
are often thought to be displaying symptoms of "mental illness." The 
PDR states that Thorazine dosage should be increased until symp- 
toms are controlled. Since every thing a mental patient does while 
hospitalized can be called a symptom, as every mental patient knows, 
as was shown by the Rosenhan study, this statement is a license to 
administer Thorazine until the patient becomes a walking zombie. 

And I saw one patient, in one of the hospitals I was in, who was 
literaly a walking zombie. Somebody stood behind here and pushed 
her shoulders gently, and she would walk in the direction she was 
pushed. And when they wanted her to turn a corner they pushed 
harder on one shoulder than the other. She was getting 2,000 mg of 
Thorazine a day. 

Although the PDR states that Thorazine is not known to cause 
psychic dependence and does not produce tolerance or addiction, it 
goes on to say that following abrupt withdrawal of high-dose therapy, 
some symptoms resembling those of physical denendence, such as 
gastritis, nausea 1 , and vomiting, dizziness and tremulousness can occur. 
Gradual reduction of dosage, rather than abrupt withdrawal, is 
suggested. 

Common sense would seem to dictate that when a drug causes such 
withdrawal symptoms, it is an addictive drug, no matter what it is 
called. 

I can state that following abrnnt withdrawal of Thorazine in a 
hospital, T experienced hot and cold flashes, nausea, stomach cramps, 
and the excruciating feeling of something crawling under the fl^sh. 
I was not warned by staff members that T would experience with- 
drawal symptoms, and while I was experiencing them, I was not 



97 

told what they were. It was only from another patient that I learned 
what was happening, and that knowledge, althought it did nothing 
to relieve the pain, at least reassured me that it had a cause, and that 
it would end. 

I know that what happened to me is not an isolated incident. I 
know many ex-mental patients who have had similar or far worse 
experiences. 

While psychiatrists may speak of the revolution in mental health 
care, that the so-called tranquilizers have brought about, it is no less 
dehumanizing to be controlled by a chemical than by a strait jacket. 

Senator Bayh. Thank you very much. I appreciate your giving us 
your recapitulation of what must have been very trying experiences 
for you. I am glad you have returned to what most of us would call 
normal. I appreciate your sharing your experience with us. 

Tony, why do you not give us your thoughts, and your background, 
and what happened to you. 

STATEMENT OF TONY LAMERE, GREAT FALLS, MONT. 

Mr. Lamere. You mean when I was in reform school ? 

Senator Bayh. Yes ; tell us, where is your home ? 

Mr. Lamere. Great Falls, Mont. 

Senator Bayh. Are your mother and father alive ? 

Mr. Lamere. Just my mom. 

Senator Bayh. Are you living with her now ? 

Mr. Lamere. No. 

Senator Bayh. How long has it been since you did live with her? 

Mr. Lamere. I do not know. 

Senator Bayh. You cannot remember living with her ? 

Mr. Lamere. I remember, but only for a few days at a time. 

Senator Bayh. Do you have any idea how old you were, when you 
stopped living with her? 

Mr. Lamere. Yes ; I live with her off and on, man. I have been on the 
streets. 

Senator Bayh. I am sorry. We are having trouble. Could you pull 
that mike up ? We just cannot hear you. I do not want to inconvenience 
you, but I surely want to hear you. 

Mr. Lamere. I cannot remember the last time I lived with her, 
because I live with her off and on for days at a time. 

Senator Bayh. Do you remember living with your father? 

Mr. Lamere. No ; I do not see much of him. I remember visiting him 
or something, but I would go see him. 

Senator Bayh. You would go see him ? 

Mr. Lamere. He would be down in Skid Row, in the bars. 

Senator Bayh. Your father is on Skid Row ? 

Mr. Lamere. Not now. He is dead. Not now, but then. 

Senator Bayh. Then he was ? 

Mr. Lamere. Yes. 

Senator Bayh. Tell us. It is my understanding that were you taken 
from living with your mother, and put in an orphanage or a boys' 
home? I do not like to ask all these personal questions; but if we are 
trying to understand the background of the things that happened to 
you, I think it is helpful to know the kind of life you were living before 



98 

you went to the boys' school, or to the orphanage, or whatever the 
situation was. 

Mr. Lamere. The reason I went was for stealing. 

Senator Bayh. You went to a boys' school for stealing? 

Mr. Lamere. Yes. 

Senator Bayh. How old were you at the time ? 

IN REFORMATORY AT AGE 13 

Mr. Lamere. When I first went, I was about 13. 

Senator Bayh. Thirteen. What did you steal ? 

Mr. Lamere. What did I steal ? I steal a lot of stuff, man. 

Senator Bayh. Give us an example of what you stole. 

Mr. Lamere. I was in the mental institution once, too ; and I have 
seen people come in there that were pretty normal, and when they left, 
they did not know nothing, man. 

Senator Bayh. You went into a mental institution ? 

Mr. Lamere. I was in one of those for 45 days. 

Senator Bayh. Why were you sent there ? 

Mr. Lamere. You see, I kept running away from reform school, and 
they kicked me out of that one. They put me there, and I got out. I 
got out of there, and I went to jail for armed robbery, and they let me 
out. When I was in the institution, the mental one, I saw this one kid — 
we called him helicopter — they took him — he knew me and this other 
kid pretty good, and they took him in to get shock treatments, and 
after he came out, he did not know us. He did not know who we were. 
He did not know where he was, or nothing. 

Senator Bayh. Were you living with your mother at the time you 
were sent to reform school ? 

Mr. Lamere. No. 

Senator Bayh. "Where were you living at that time? 

Mr. Lamere. I was living all over, no place, really. 

Senator Bayh. You were just living out in the streets ? 

Mr. Lamere. Sometimes. I would stay at my grandmother's for 
maybe a dav, and I would cut out for somewhere else. 

Senator Bayh. Was any effort made to try to find a more normal 
type of home for you to live ? 

Mr. Lamere. No, the only place that people thought was normal was 
reform school. 

Senator Bayh. What was reform school like ? 

CUSTODY IN REFORM SCHOOL 

Mr. Lamere. If vou want to get through with it, vou have got to 
get in trouble. You have got to do what the rest of the kids do. 
' Senator Bayh. You were aged 13 when you went to reform school? 

Mr. Lamere. Yes. 

Senator Bayh. How many other boys were in reform school ? 

Mr. Lamere. About 150;'sometimes 80. At the most, there were 150. 

Senator Bayh. What tvpe of custody was this? Did you live in one 
big room, or cottages, or what ? 

Mr. Lamere. They had cottages. 

Senator Bayh. How many boys lived in each cottage? 

Mr. Lamere. About 30. 



99 

Senator Bayh. Thirty boys in each cottage? 

Mr. LAMERE.Yes. 

Senator Bayh. How many adult supervisors did you have ? Did you 
have a mother and father for each cottage, or what ? 

Mr. Lamere. No, they had a man. 

Senator Bayh. How many men for each cottage ? 

Mr. Lamere. Two or three. 

Senator Bayh. Two or three ? 

Mr. Lamere. Yes. 

Senator Bayh. What did you do while you were there ? Did you go 
to school ? Did you run machines ? Did you run a farm, milk cows ? 
What kind of a reform school was it ? 

Mr. Lamere. They had all kinds of stuff. They had auto shop, dairy 
farm, rented farm equipment and stuff like that. 

Senator Bayh. What did you do, at age 13 ? What did they have you 
do? 

Mr. Lamere. I was going to school then. I was in Twin Bridges, it 
was a children's center. 

Senator Bayh. Was Twin Bridges a public school, and then you 
lived at the reform school, or what? 

Mr. Lamere. No, it was on the reform school. They had a school right 
there. 

Senator Bayh. Did you like that school ? 

Mr. Lamere. No. 

Senator Bayh. Why ? 

Mr. Lamere. Because after I got back from school, I had to get in 
my pajamas, scrub walls all day, and floors, sweep rocks off the stairs. 

Senator Bayh. You ran away from there, is that right ? 

Mr. Lamere. Yes. 

Senator Bayh. Why did you run away ? 

Mr. Lamere. I could not handle it. 

Senator Bayh. You could not handle it ? 

Mr. Lamere. No. 

Senator Bayh. Why could you not handle it ? 

Mr. Lamere. I do not know. Because of the people. 

Senator Bavh. What did they do to you ? 

Mr. Lamere. They messed me over. 

Senator Bayh. When you say messed you over, tell me, what does 
that mean? What did they do to you when they messed you over? 

Mr. Lamere. Like, for any little thing, man, like walking past the 
office or something, you have got to wash walls or something like that, 
just for little things. 

Senator Rath. Where did you run to, when you ran away from 
reform school ? 

LIVING ON THE "STREETS" 

Mr. Lamere. Different towns like Helena, Great Falls, up on the 
reservation. 

Senator Bayh. How did you live there? 

Mr. Lxmere. Off the people, man. T stole. That is the only reason I 
ever stole, was to eat and stuff, maybe to get things I never have, be- 
cause I could not work. 

Senator Bayh. You were 12 to 14 years old at this time ? 



100 

Mr. Lamere. Yes ; all the way up until I was about 16, or 15 years 
old, I was in reform school. 

Senator Bayh. And they put you in a mental institution because you 
ran away from reform school ? 

Mr. Lamere. Yes ; they put me there until I was— I had to stay there 
until I went to court. I stayed there, and that is where I saw all the 
people get messed up on Thorazine and stuff. They give it to them 
when they did not want to take it, and they give them shock treat- 
ments. And a lot of the people that did not want it. 

Senator Bayh. Did they give it to you ? 

Mr. Lamere. No; the judge put me in there. They could not touch 
me. I was just there, staying there, until I went to court. 

Senator Bayh. Did you see what happened to other people while 
you were there ? 

Mr. Lamere. I saw them — it is like maximum security cells, and I 
saw them put this one guy in there, and they beat him up, and they 
strapped him down, and spiked him up with some stuff. I do not know 
what is was. And they left him in there. 

Senator Bayh. They gave him a shot — is that what you mean when 
you say "spike"? 

Mr. Lamere. Yes. 

Senator Bayh. What happened to him when he got spiked ? 

Mr. Lamere. He laid there. That was it, for about a day and a half 
or so. 

Senator Bayh. Were you living in the same room, or the same 
dormitory together? 

Mr. Lamere. Yes ; I was living in the same, like, ward, or whatever 
it is. 

Senator Bayh. But you had no personal experience with this 
yourself ? 

Mr. Lamere. No; I saw it happen. I talked to people. They would 
come out, you know, they would come out, and they did not know me 
or anything. Before they drugged them, or before they took them to 
get drug treatment, they knew who I was. 

Senator Bayh. Was this a normal kind of treatment ? 

Mr. Lamere. It was to stop them from trying to cut out. 

Senator Bayh. Punishments? They thought someone might try to 
run away, and they would give them a shot? 

Mr. Lamere. Yes ; just to have control over them, so they could not 
do anything violent. They would be too lazy, and stuff. 

Senator Bayh. Is this the kind of treatment where one shot follows 
another and followed by another shot? 

Mr. Lamere. Yes; if "somebody says that you are going to run away 
or something, even if you did not say it, they will drag you, just so you 
do not do anything. 

Senator Bayh. What happened to you after you got out of there? 

Mr. Lamere. I went to court, and they let me go ; -1 days later, I went 
back to jail. 

Senator Bayh. Did you do something 4 days later? 

Mr. Lamere. Yes; I robbed a taxicab, and I was in jail for armed 
robbery. I got out about 30 days later, and after that, I stole a beer 
truck and stuff. 

Senator Bayh. You stole a beer truck ? 



101 

Mr. Lamere. Yes ; I went to Pine Hills School. 

Senator Bayh. And what did yon do in Pine Hills ? 

Mr. Lamere. I got locked up. I knew a lot of kids in maximum 
security. There are three different jails, and they drug you down there, 
so you do not try to jump some people down in there, their housepar- 
ents, or security guards. 

Senator Bayh. Did they drug you there? 

Mr. Lamere. No; I did not^go in there. But I knew the kids that 
went in there. There was one kid in there, after I got out. He was in 
there for maybe 3 months, and after I got out, this one kid I saw— I 
asked him about this other kid who was still in there. That was about 
9 months later, and he did not get out, He was probably in phase 1 for 
9 months. 

Senator Bayh. How old was he ? 

Mr. Lamere. About, about, 16. His name was Lloyd Baker. 

Senator Bayh. How old were you when you were there at the time? 

Mr. Lamere. About 16 or 15. 

Senator Bayh. How long did you stay there? 

Mr. Lamere. I only stayed there for 45 days. I got valuated. 

Senator Bayh. You got what ? 

Mr. Lamere. I got valuated. 

Senator Bayh. What happened when you got valuated ? 

Mr. Lamere. Nothing. I just had to stay there until I went back to 
court. I never went back to court. 

Senator Bayh. Where did you go ? 

Mr. Lamere. I went back to Great Falls to stay, and waited around 
for court, and it never did come along. I never did have to go to court. 

Senator Bayh. What are you doing now ? 

STILL LIVING OFF THE STREET 

Mr. Lamere. What am I doing now? Nothing, man; just trying to 
make a living off the streets. 

Senator Bayh. Trying to make a living off the street ? 

Mr. Lamere. Yes; I cannot get a job down there. All the people tell 
me if I work for them, everything they had, they would have to nail 
down, so I cannot get a job. They do not trust me. 

Senator Bayh. Well, you were in the institutions. You talk about 
people who were injected with drugs, or given drugs, for running 
away. Did you have a chance to observe the patients or inmates in the 
institutions get various kinds of street drugs, marihuana, heroin, barbs, 
speed ? 

Mr. Lamere. I knew a kid who was getting some joints off the street ; 

y es - 

Senator Bayh. While he was in the institution ? 

Mr. Lamere. Yes. 

Senator Bayh. What institution was that ? 

Mr. Lamere. It was Warm Springs Mental Hospital. 

Senator Bayh. How was he getting them ? 

Mr. Lamere. He was getting them through the visitors. 

Senator Bayh. Through the visitors? 

Mr. Lamere. Yes. 

Senator Bayh. What kind of drug was it? 



102 

Mr. Lamere. I do not know what kind, but he told me — he offered 
me some that day. And I was not around, so he took it all. I think it 
was downers, or something like that. 

Senator Bayh. You are how old now ? 

Mr. Lamere. Eighteen. 

Senator Bayh. What would you like to do with your life ? You say 
you are living off the streets. What would you like to do ? 

Mr. Lamere. I would like to help people, like work in a mental in- 
stitution, where I could find out what is going on, and help the people, 
man. 

Senator Bayh. Do you ever see your mother now ? 

Mr. Lamere. Yes; I go out and see her every now and then. 

Senator Bayh. Where does she live? 

Mr. Lamere. She lives in the same town that I do. She is married to 
a fellow who don't like me, so I cannot go out there. 

Senator Bayh. Could you tell us why you have that arrow ? 

Mr. Lamere. Yes, because I like it, man. 

Senator Bayh. Does that symbolize something to you ? 

Mr. Lamere. Yes, my people. 

Senator Bayh. You are of Indian background ? 

Mr. Lamere. Yes. 

Senator Bayh. Did your parents live on the reservation ? Did you 
ever live on the reservation ? 

Mr. Lamere. No; but my grandma did. I got cousins who live on 
reservations too. My sister lived on one for a while, my nephew, a lot 
of people live on reservations. 

Senator Bayh. What are they doing now, your sister and nephew ? 

Mr. Lamere. She is married. My nephew is her son. They live in 
Portland, Oreg. I do not know her husband. I did not see him. 

Senator Bayh. Are you really making an effort to get a job? 

Mr. Lamere. Yes, but I cannot get one because of my record. I could 
not even get into the public schools. 

Senator Bayh. Would you like to go to school ? 

Mr. Lamere. Yes ; I tried to get into public school about a year or 2 
ago, and I could not get in there. 

Senator Bayh. Now, you have been in schools, I suppose. You men- 
tioned, a moment ago, that when you were in the reformatory they had 
a school there. 

Mr. Lamere. Yes ; I did not like being in the reform school. I was 
not in school very much. I was always gone until I would get caught, 

Senator Bayh. Tony, thank you very much for being with us. 
Thanks to all of you for taking the time and letting us have your per- 
sonal experience. I know it is a difficult thing to bare your soul like 
this. I appreciate your helping us get a better feel for what has actually 
happened, so we will know better what to do. 

Thank you for being with us, and I appreciate it very much. You are 
all excused. 

Our next panel is a panel of medical experts who will give us their 
experience and insights on these problems. Dr. James Clements, direc- 
tor of the Georgia Retardation Center at Atlanta and immediate past 
president of the American Association of Mental Defeciency; Dr. 
Herbert A. Wendel, Division of Clinical Pharmacology, University of 
Oregon Medical School; Dr. Edward Kaufman, medical director of 



103 

the Lower Eastside Service Center in New York, former director of 
Psychiatric Health Services of New York City Prison System, and 
chief of Psychiatric Service in Lewisburg Federal Penitentiary. 

Am I accurate that it is Dr. Clements, Dr. Kaufman, and Dr. Wen- 
del ? Is that the proper order ? 

We appreciate you gentlemen being here. Why do we not just start 
with you Dr. Kaufman, and we will go from left to right, if there is no 
other reason for doing otherwise. 

PANEL OF MEDICAL EXPERTS 

STATEMENT OF DR. EDWARD KAUFMAN, MEDICAL DIRECTOR, 
LOWER EASTSIDE SERVICE CENTER 

Dr. Kaufman. I am Dr. Edward Kaufman. I am psychiatrist. I am 
presently working as the medical director of the Lower Eastside Serv- 
ice Center which is a multimodality drug treatment program in New 
York City, and I am also on the faculty of Mount Sinai College of 
Medicine and Columbia Psychoanalytic Institute. 

Senator Bayh. When you say, "multimodality treatment center," 
exactly what do you mean, Dr. Kaufman ? 

Dr. Kaufman. It means that we have six different programs that are 
tied to the needs of the different patients, so that some of our programs 
are drug free, involving classic psychotherapy, and some are full day 
programs. In some of our programs we use methadone. In one of our 
programs, we are dedicated to getting people off of methadone. It is 
called a methadone-to-abstinence program. 

Senator Bayh. To a drug- free existence then ? 

Dr. Kaufman. Yes. 

Senator Bayh. That particular program is to deal with those who 
are drug addicts right now ? 

Dr. Kaufman. Right. 

Senator Bayh. Do you still have the responsibility, that I referred 
to earlier, at Lewisburg ? 

Dr. Kaufman. No; I was the director of psychiatric services at 
Lewisburg Federal Penitentiary from 1964 to 1966, and then more 
recently until early 1973, I was director of psychiatric services for the 
New York City prisons, but I do not have that responsibility now. 

Senator Bayh. All right, please proceed. 

Dr. Kaufman. Well, I think I was asked to come here mainly to talk 
about my experiences at some of the prisons I have been in and some of 
the prisons I have evaluated. 

AREAS OF COMMITTEE'S CONCERN 

Senator Bayh. Just so we can focus in on this. None of your testi- 
mony needs to be exclusively confined to this aspect, You are all very 
busy men. 

One primary interest, today, is to the extent drugs — that have a 
medical purpose in treating mental illness or abnormalities — are 
abused and used for other purposes, such as making easy custodial care. 
We are also concerned about the availability of street drugs in some of 
our institutions. 



104 

And, I must say after listening to Tony testify, it goes back to the 
broader concern that I have had for a long period of time, which led 
to the enactment of the Juvenile Justice Act. This act was designed to 
get away from some of the stereotype responses to children or juvenile 
problems, which compound and make those problems worse. 

And it has been the judgment of this committee, Congress, and some 
50 youth organizations — we have been able to get everybody but the 
President of the United States to concur, because so far he has not 
implemented this legislation — if we are going to deal with the prob- 
lems of crime and perhaps even cases of mental illness, that it is a lot 
easier to deal with them at a time of life when habits have not been 
formed, to try to deal with the problems that exist in the home, or in 
the school, or in the general community at an earlier age in a child's 
life. Thus, you do not ultimately end lip with someone who has been 
through three, four, or five institutions — many of which compound 
the problem and ensure that it is going to be more severe in its next 
manifestation. 

Now, that gives you a background of where I am concerned ; but it 
does not mean that you need to respond specifically to those concerns. 

Dr. Kaufman. Well, I wanted to start off then with some comments 
about the six panelists that preceded me. I think in a lot of ways I 
agree with everything that they say, and I am sure that there are 
many, many people who go through a lot of the kinds of experiences 
that they described, but I think that maybe some point has to be made 
for the other side about some of these drugs too, and I would like to 
start off briefly 

Senator Bayh. Well, let me say as chairman of this committee, we 
are not here with any preconceived notions. 

I, personally as a layman, feel there is a place for psychiatry, and 
in addressing ourselves to the problems of the mind. Psychiatric treat- 
ment, and those individuals who bear that title of psychiatrists, are 
like all other professional people and all the citizens, including public 
officials — there are some good, and I am sure there are some bad. So 
your opinion and your expertise will certainly be respected. 

Dr. Kaufman. That is certainly true with a drug like Thorazine. It 
has some good uses, and it has some bad uses, and in a little while I will 
talk about some of the bad uses in institutions. 

But clinically it has been a very, very valuable drug. I have always 
been dedicated to getting people off of Thorazine or other drugs as 
rapidly as possible, but there are some people who, were it not for 
Thorazine at some point in the past or were it not for Thorazine in 
the present, would be unable to function, and a lot of patients that I 
have treated have been helped by Thorazine. 

All of the side effects are certainly ones that you worry about, but 
it certainly can be an extremely beneficial drug. 

Senator Bayh. Give us an example of the beneficial treatment, the 
kind of patient, and the normal kind of reaction that a doctor would 
like to see by utilizing Thorazine — applied in the right place at the 



right time. 



BENEFICIAL USAGE OF THORAZINE 



Dr. Kaufman. There are two patients in particular that come to my 
mind. One of them was a young man in his early twenties who was in 
the hospital and under treatment with Thorazine, and he was trans- 



105 

ferred to my care. This was about 2V 2 years ago. He was able to get 
out of the hospital in about 1 month, and following that time he went 
back to school, and he stayed on Thorazine for about \y 2 years after 
coming out of the hospital. 

Now, he has had no Thorazine at all for over 6 months, and he has 
no need for it. We still continue to work in treatment. He is leading a 
very creative life as a student. 

Another patient is a college professor who has had two very brief 
nervous breakdowns of about 2 weeks in duration. Each of these times 
he was in mental hospitals. It has now been about 4 years since his last 
breakdown. During that time he has continued to take Thorazine. He 
is out of the country now, and he is totally capable of monitoring his 
own medication. If he gets into trouble with it, he will write me 
a letter, and I will answer with some instructions as to how to take it, 
but over the past 4 years this individual has been functioning as a 
highly renowned scholar and college professor, and he still takes Thor- 
azine. 

And I expect when he returns to this country very shortly, he will 
drop in and see me again, and we will continue this 5- or 6-year rela- 
tionship we have had in which psychotherapy is a very important part, 
but so is Thorazine. 

Senator Bayh. What is the clinical diagnosis? What is the type of 
problem that someone would have for which you would prescribe 
Thorazine ? 

Dr. Kaufman. To speak generally, Thorazine is used for schizo- 
phrenia as a rule, and generally I am somewhat specific on my diag- 
nosis of what constitutes schizophrenia. 

Senator Bayh. Tell us what that is and the way you describe it. 

Dr. Kaufman. Well, something we teach medical students is that 
there are primary symptoms of schizophrenia and there are secondary 
symptoms of schizophrenia, and the primary symptoms are the four 
A's: affect, association, ambivalence, and autism, and what that means 
in terms of affect, that is emotionality. That means if a person's emo- 
tionality is flattened or maybe very labile — which means fly off the 
handle rapidly or switch rapidly from one mood to the other. 

Autism refers to preoccupation with a fantasy world, a withdrawal 
from reality. 

Ambivalence refers to the simultaneous experience of very different 
kinds of emotions and actions so that although all of us have some am- 
bivalence, somebody who is schizophrenic and is ambivalent simulta- 
neously feels enormous hostility and enormous love for the same hu- 
man being. 

And association has to do with the person's thought linkages, that 
there is a loosening of the thought processes. 

And the secondary symptoms are things like delusions, that is, false 
beliefs, like we heard of the FBI following people, although in some 
cases it can be reality. 

And the other secondary symptoms are hallucinations, which are 
seeing or hearing or smelling things that are not really there. 

Now, Thorazine seems to have a specific effect on this symptom pic- 
ture, particularly in an acute break. If somebody has an illness that is 
only a few days old, and you intervene in a very deep personal way 



106 

with them and you give them Thorazine, you can frequently get them 
over it in a week or two. 

There is another aspect of Thorazine too, and that is that some 
researchers have found that statistically if someone has had significant 
mental illness, that if you maintain them on Thorazine, the chances of 
their having another such episode are decreased enormously, so that 
a lot of times, almost like digitalis for heart disease, some of us will 
keep people on Thorazine after there are no symptoms, with the idea 
behind it that it will r> re vent a recurrence of such a break. 

Senator Bayh. What would be the normal amounts of Thorazine 
maintenance dosage? 

THORAZINE MAINTENANCE TREATMENT DOSAGE 

Dr. Kaufman. Well, most of my patients, when they are outpatients, 
are on 100 to 200 milligrams of Thorazine. The PDR, which was 
quoted before, talks about closes of around 1,000 milligrams and says 
that 2,000 milligrams is also acceptable under certain circumstances, 
and I personally have prescribed very high doses of Thorazine to peo- 
ple. It has been a long time since I have clone it, and it has been more 
associated with my work in hospitals. I work more with outpatients 
now, so it is less necessary. 

So that a dose of 100, 200, 300 milligrams of Thorazine is not really 
unusual. I think a lot of people have been misdiagnosed, as the pre- 
vious panel described. There agitation as a result of a side effect of the 
drug has been mistaken for psychosis, and the drug has unfortunately 
been increased. I hope that now we get more in tune with that kind of 
picture, so that we give the appropriate antidotes, rather than giving 
more Thorazine. 

Senator Bayh. Well, is a 2,000-milligram dose of Thorazine a com- 
mon kind of practice institutionally ? 

Dr. Kaufman. I would say if you walked into most of the psychiat- 
ric hospitals in this country, you would find some people on a dose 
of Thorazine that high, the minority certainly, but in general it is 
not that shocking to hear about a dose of Thorazine that high. 

Senator Bayh. It may not be that shocking, but is it wise ? 

Dr. Kaufman. In some cases, it is. I would be very critical of this 
kind of dose, and I would want to review the case very carefully, but in 
some cases it is the only way people can be helped. 

Senator Bayh. A response was relayed to us from a witness of a 
doctor who was supposed to have said, "Well, those precautions that 
are listed on the package by the drug firm, they are always overly cau- 
tious." Is that a normal reaction? 

Dr. Kaufman. Well, there are some people who have had experience 
in using higher closes than those dictated by the packaging. I think the 
packaging in this case says that a dose up to 2,000 can be used so that 
for this doctor to use 2,000 does not even exceed the packaging 
instructions. 

I think for most drugs, it is very safe guidelines to not exceed the 
packaging directions, so that I generally avoid exceeding what the 
usual instructions are. 

Senator Bayh. From your professional experience — working with 
patients or inmates in an institutional setting — have you experienced 



107 

or do you have reason to believe that the practice of using pheno- 
thiazines for a sedative purpose, not for therapeutic purposes, is that 
which is being followed? 

Dr. Kaufman. I think there are a lot of institutions where pheno- 
thiazines are being used to keep people quiet. I think that prisons 
particularly are an example where phenothiazines are used to keep 
people quiet, and I like to think that in the prisons in which I have 
worked or in which I have supervised that this has not been the case, 
although it is sometimes a very difficult picture. 

But the situation where I w r as very clearly exposed to this was at 
the Goshen State Training School in Goshen, N.Y., recently. About 
a year ago Legal Aid Prisoners' Rights Project asked me to go up 
there and take a look at the situation, and I was really appalled at the 
way phenothiazines were used there. 

Senator Bath. Could you tell us how they were used? 

Dr. Kaufman. First of all, there is a word "prh w in medicine, which 
means "as needed," and every individual that entered the Goshen 
State Training School at that time — that was in April 1974. had a 
telephone order taken by the nurse from the doctor, without the doctor 
examining the patient, which stated: "Thorazine, 25 milligrams, 
intramuscularly, prn," so that without any kind of medical or psychi- 
atric evaluation whatsoever, the nurse wdio was very frequently in- 
fluenced by the custodial staff was given license to administer 
Thorazine. 

Senator Bath. What would be the normal reaction to that dosage 
of Thorazine ? 

DANGERS OF THORAZINE INTRAMUSCULAR INJECTIONS 

Dr. Kaufman. I think there is an important point about intra- 
muscular Thorazine. When we talk about dosages here, and I talk 
about giving fairly high doses of oral medication if necessary, but 
I am much more conservative about intramuscular medication, so that 
I never give more than 25 mg intramuscularly. 

One of the reasons for this is that you get much higher peaks in 
the blood of Thorazine when given intramuscularly. The peak of 
intramuscular Thorazine is about 10 times as high as that of oral 
Thorazine, so that the risk of some side effects is 10 times as great 
when you give it by injection, so if you are giving somebody in injec- 
tion of 25 mg of Thorazine — or in a couple of cases, 50 mg of Thorazine, 
which was given here without an order — you run a very high risk 
of certain side effects. 

One of the individuals that got such an injection of Thorazine had 
epilepsy, and Thorazine can precipitate an epileptic attack, particu- 
larly in someone who is vulnerable. 

Senator Bath. Can it precipitate a heart attack? Heart arrest? 

Dr. Kaufman. Conceivably, it can. I saw a man once who got 25 mg 
of Thorazine orally and whose heart actually stopped beating in the 
hospital directly as a result of that. That is highly unusual. Most 
people have never seen that. This was 15 years ago, and I will never 
forget it. Fortunately, he was in a medical facility, and there seemed 
to be no permanent difficulties. 



108 

Thorazine can cause electrocardiographic changes with some fre- 
quency, and although I have never seen a heart attack from it, I did 
see somebody's heart stop from it. It causes a lowering of blood pres- 
sure and in somebody whose heart is vulnerable, it certainly could 
conceivably cause a heart attack. 

Senator Bayh. Then the prescription of 25 nig intramuscularly 
administered — without a doctor having examined the patient — would 
then have the effect of immediate sedation. Would that not be the 
reaction ? 

Dr. Kaufman. Right. That would be the main reason to give it, and 
most of the time that would work and would sedate the individual. 
Frequently, there would he the kinds of experiences that were described 
earlier here. There would be some mental confusion, a feeling of not 
being real. The tiredness is a very alien kind of tiredness, and although 
it sedates, it can also be a very frightening experience. 

Senator Bayh. Did you have knowledge, in your investigation at 
Goshen, of children who were given that kind of treatment for very 
minimal kinds of abuse such as not washing or using the wrong kind 
of words, or this kind of misconduct ? 

THORAZINE USE AS COERCIVE PUNISHMENT 

Dr. Kaufman. Well, what happened was, very frequently conflicts 
started that way. There was one specific individual where the fight with 
the custodial force started because he was told to wash his hands, and 
he said he had washed them half an hour before, and this fight esca- 
lated into a physical struggle, and it ended up that he was given on 
this occasion either 25 or 50 mg of Thorazine intramuscularly and 
put in seclusion for a rather long period of time. 

But this same individual was also threatened frequently, if you do 
not go to work now, we will put you in seclusion and give you a shot 
of Thorazine, so it was certainly used in a very coercive and punitive 
way. 

Senator Bayh. I just wanted to nail that down. In other words, the 
experiences that have been described by earlier witnesses are not what 
you would call isolated examples? 

Dr. Kaufman. Right, they certainly happen, and as of last year 
at the Goshen State Training School, there was an order written so 
that every young person in that school could be given a shot of Thora- 
zine without any medical evaluation to decide whether he should have 
it or not. Also the order was rewritten about every month or so, and in 
none of the charts that I read was there the slightest mention of intra- 
muscular Thorazine, as to how it was to be used for the individual's 
benefit or how it was a part of the treatment plan. 

Senator Bayh. We are not talking about the experience you had with 
the use of Thorazine as a treatment to mental disability \ 

Dr. Kaufman. Right. 

Senator Bayh. That is what you discussed earlier as the use of 
Thorazine to have a salutary effect, 

You are now relating to an institution for juvenile delinquents. 
There instead of Thorazine being used for treatment of mental dis- 
ability, it was being used as a mental handcuff. Here, if you are not 
good, they are going to slap you down, stick a needle of Thorazine 



109 

in you, so you will go to sleep, then they will not have to worry about 
you. Is that what you are talking about ? 

Dr. Kaufman. Right. My feeling about it was that it was very much 
like how wild animals are captured in the jungle. It was not much 
above that, where the doctors order over the phone ; with the nurses' 
permission essentially, the guards were shooting a Thorazine gun at 
these unfortunate people to control their violent behavior, which they 
had indeed done a great deal to provoke. 

Senator Bayh. Did these security guards — who had the initial re- 
sponsibility for ordering this treatment — have much experience in the 
medical aspect of this % 

Dr. Kaufman. Their medical training, of course, was quite limited. 
I did talk to the security guards, and I did not find them to be par- 
ticularly knowledgeable in anything psychiatric or medical. 

Senator Bayh. That is not unusual, is it? A normal security guard 
would not be expected to have a Ph. D. or an M.D. ? 

Dr. Kaufman. Eight. 

Senator Bayh. I say that without being derogatory toward security 
guards. I do not think that is a prerequisite for hiring a security 
guard. 

Please proceed. 

DRUG ABUSE PROBLEMS IN PRISONS 

Dr. Kaufman. I think that is basically the summation of my expe- 
rience at Goshen. I think to very briefly discuss my experience on the 
other side when I was the director of Prison Psychiatric Services in 
New York City, I came in and I found that intramuscular Thorazine 
was being abused there, and so I changed the guidelines for the use of 
intramuscular Thorazine. 

I also tried to change the guidelines for the use of all psychotropic 
drugs, and I felt that even minor tranquilizers, such as Valium or 
Librium, should be avoided in a prison setting, unless the person has 
a genuine kind of psychiatric syndrome. 

Now, prisoners get very bored. One way to deal with boredom is to 
take drugs. A lot of the prisoners are drug addicts or were drug ad- 
dicts, and they are used to having a chemical to alter their state of 
mind, and despite the fact that I issued strict guidelines against the 
mass prescribing of these drugs, there were certain doctors who found 
it very difficult not to do so. These people were very desperate, and 
had a lot of anxiety and a lot of depression, and some of the doctors 
that worked for me felt it was their obligation to relieve this anxiety. 

So that one of the prison psychiatric services which I was in charge 
of — and there were nine others — the doctor put maybe 50 or 75 of the 
people on Valium or Librium, so in a sense he was really creating a 
drug problem. Now, none of these people were on seriously high doses, 
but nevertheless it has the problem of perpetuating the use of a drug 
for a solution, and it also provides pills around the institutions, and 
no matter what you do, no matter what kind of flashlight you shove 
down somebody's mouth when they take pills, if you have pills in the 
institution, people are going to save them, and if people are going to 
save pills, they are going to abuse them. 



83-303 — 77- 



110 

So that in a lot of institutions, you hear that you can get a Valium 
for a pack of cigarettes. Thorazine is generally not an abused drug, 
and maybe you could get four or five Thorazine for a pack of cigarettes 
if you could find a customer, so that institutions frequently create their 
own drug problems through well-meaning doctors prescribing mod- 
erate doses of medication, and there is very little to do about some- 
thing like that. You can threaten a doctor that he will lose his job if 
he continues to prescribe the drugs, or you can ban the drugs totally, 
which I was very tempted to do, but did not, so that even in some of my 
own institutions where I have been ultimately responsible, we have 
had a drug problem. 

Senator Bath. Do you have institutions where people with no pro- 
fessional training, whatsoever, are in a position of being custodians of 
the medicine cabinet ? 

Dr. Kaufman. I have heard of that in the past. I think Goshen prior 
to my coming there, the officers had a lot more direct input into giving 
medication. Also, in the New York City system before I came into the 
system, the correction officers would dispense the pills. They would be 
written by the doctors, and theoretically they could only dispense them 
as the doctor wrote the directions. 

This was a situation that we very rapidly moved into to do away 
with although it took the hiring of about 50 nurses to be able to do so. 
so there are a lot of situations where custodial people have a great deal 
of control over medication. 

Senator Bayh. When you have "prn" notification the correction 
officer, theoretically, then could regularly rely on that and their divert 
the drugs to other destinations ? 

Dr. Kaufman. I think the prn should be used with the nurse dispens- 
ing only in the direst of circumstances, and I think the prn should never 
be used with anybody other than a professional person so that custodial 
officers dispensing on a prn basis is a very dangerous and disruptive 
situation. 

Senator Bath. Thank you. I interrupted you with questions, but I 
appreciate your contribution here very much. 

Dr. Kaufman. Thank you. 

Is it possible for me to leave at this point ? I would greatly appreci- 
ate that. 

Senator Bath. You may be excused now. Again, I appreciate 
very much, Dr. Kaufman, your letting us have the benefit of your 
experiences. 

Dr. Clements, will you proceed. 

Dr. Clements. Would you like me to read the prepared statement, or 
how would you like me to proceed ? 

Senator Bayh. I would like you to give us the main thrust of your 
thinking, and of course you have had significant amounts of profes- 
sional experience here. I might add, that we will put your entire state- 
ment x in the record as if you have read it. I am sure you gave it a great 
deal of thought. 

1 See p. 119. 



Ill 

STATEMENT OF DR. JAMES CLEMENTS, DIRECTOR, GEORGIA 
RETARDATION CENTER, ATLANTA, GA. 

Dr. Clements. I would like to say that some of my professional cre- 
dentials are not very meaningful, relating to this issue. I am assist- 
ant professor of psychiatry at Emory University. I am assistant pro- 
fessor of pediatrics at Emory and associate professor of neurology and 
assistant professor of pediatrics at the Medical College of Georgia. 

My major job is as director of an institution for the mentally re- 
tarded, and my experience and interest in this field comes out of doing 
evaluations of a number of institutions for the mentally retarded in 
this country. I have evaluated over 15 institutions which house more 
than 20,000 mentally retarded people. 

It is the direct observations that I have made in these institutions 
that cause me to be concerned about the abuse and misuse of psyco- 
pharmacologic agents, the group of drugs we generally refer to as 
tranquilizers within these institutions. 

Another very large area of my concern about the drug problem 
relates back to why do we do this, and who does it? The basic respon- 
sibility has to go back to the physician, but I think one is rather 
appalled when one takes a look at what physicians do know and do 
not know about, for example, mental retardation and psychopharma- 
cology. 

The principal textbook used in medical schools in this country for 
training of pediatricians and other physicians about problems of 
children is "Nelson's Textbook of Pediatrics." This book has approx- 
imately 1,589 pages : roughly 12 of these pages is about mental retarda- 
tion, and contains a statement that mental retardation is probably 
the most handicapping of all conditions of childhood. 

Out of that 1,589 pages, we get this very small encapsulation of this 
devastating condition of childhood. 

Senator Bath. When was "Nelson" published ? 

Dr. Clements. "Nelson" is published every 4 years. 

Senator Bath. Every 4 years ? 

Dr. Clements That is correct. 

The other major source of information, of course, is scientific jour- 
nals^ which relate basically to clinical reports and research. For exam- 
ple, in our library at the Georgia Retardation Center, we have some 
200 of these journals published monthly and bimonthly. Now, how 
can a physician even peruse the information from all of these journals ? 

PDR AND DRUG SALESMEN INFLUENCE 

The basic information about drugs for practicing physicians comes 
from the PDR, and the PDR descriptions of the drugs are basically 
prepared by the manufacturers, so we have three basic sources here 
that we are dealing with. We have what we are taught in medical 
school; we have what we read following medical school; but our 
primary source of postgraduate education in drugs is by the PDR and 
drug salesmen. 



112 

Granted this drug salesman knows his product. He frequently is 
quite an authority on the products prepared by his company, but what 
does he know about diagnosis? What does he know about mental 
retardation? What does he know about behavior disorders for which 
these drugs are being prescribed? tot 

And let us face it, sir, his primary job is to sell the product, bo 1 
think we have a multif aceted problem here in that we have not enough 
information about the drugs, and I would like to say a little more 
about those people who prescribe these drugs in institutions for the 
mentally retarded. % „ 

In the institutions that I have seen, the drugs are prescribed officially 
by a physician. Actually, the order for that drug usually originates 
with basically untrained attendants in these hospitals. What are these 
drugs prescribed for, and why are the attendants wanting mentally 
retarded people placed on these drugs ? 

They are prescribed for head-banging, agitation, feces-smeanng, 
masturbation, and so forth. These are all situational disorders, basi- 
cally due to the environment that a person finds himself in. They are 
caused by the very environments in which these people live, and yet 
here we are prescribing pills to eradicate the behavior due to the very 
environment creating these behaviors. 

Senator Bayh. Let me, as a layman, make certain that I understand 
what you are saying. Is this sort of a Catch 22-type situation where 
a child is placed in an environment which causes certain disorders or 
abnormalities, and then drugs are prescribed to stop the reaction to the 
environment in which the child has been placed ? 

Dr. Clements. That is correct, sir. In essence the drugs are pre- 
scribed to stop the behavior caused wholly or in part by the environ- 
ment in which the person has been placed. 

Now, if you have not been in an institution for the mentally re- 
tarded, let me describe for you briefly what the living setting is. You 
have a large clayroom. You have a large sleeping area m which there 
are usually not dividers between beds and certainly no appropriate 
dividers. Anywhere from 30 to 60 to 90 people may sleep in this large 
room. Disturbances during sleep become a way of life. People do 
things in large groups. They eat in large groups. They sit in large 
groups. They sleep in large groups. They go to the toilet in large 
groups, and "everything they do is in large groups. 

Because of the tile walls and the tile floors that are very common in 
these situations, it is impossible to carry on an ordinary conversation. 
There is very little or any organized activity. Frequently, one will find 
one untrained and unskilled attendant trying to care for all of the 
needs of 30 to 60 of these retarded people, and there is no way possi- 
ble this person can do it, so in essence you go into a dayroom — and this 
is unfortunately a typical thing that I am describing to you— and you 
see 30 to 60 people milling about, sitting, rocking, head-banging, muti- 
lating themselves, masturbating — this is a typical picture that you see, 
and this is what we are prescribing the pills for. 

Senator Bath. May I ask you, is this true also for young people ? 

Dr. Clements. Yes ; I would say that the average population age- 
wise in institutions for the mentally retarded would be probably 50 



113 

percent of these individuals would be between the age of 10 and 20, and 
about an equal distribution on each side. 

Senator Bath. Is it a typical setting. Doctor, to find a 10-year-old 
child who is mentally retarded commingled in this group setting with 
someone who is 50, 60, or TO ? 

Dr. Clements. Ordinarily, there is a little more close grouping by 
age groups in institutions for the mentally retarded than what I have 
heard about institutions for the mentally ill. The ages may be indeed 
broad, from 10 years of age to 20 or 30, or 20 years of age to 80. 

It is also quite different in the physical size of people, and when you 
have a lot of very agitated people around who have no direction and 
nothing to do, size does become important, particularly for the smaller 
person, and the smaller person is frequently injured in this situation, 
perhaps not intentionally, but again the person doing the injuring 
most likely would be called abusive, destructive, and would almost in- 
evitably be placed on a tranquilizing drug. 

UNTRAINED PERSONNEL "PRESCRIBE" MEDICATION 

I think one thing that is so frightening about all of this is that we 
assume — I would say those of us who have not been in these institu- 
tions — that drugs are given in a very scientific fashion. This indeed is 
not the case. They are simply given basically from reports described 
by untrained ward attendants. The untrained ward attendant will go 
to a doctor and say, Johnny did such and such. He needs a pill, and 
Johnny gets a pill. 

How does a doctor get information back about how the pill is af- 
fecting Johnny? The untrained ward attendant says, Johny is bet- 
ter now that he has gotten the pill. That is about as scientific as it ever 
gets. 

You would assume, not having been there, that people who are dis- 
pensing controlled drugs are people that are trained and indeed licensed 
to do so. At all of the institutions I have ever been in, not in a single 
one did they require a licensed nurse to dispense these medications. 

Senator Bath. Not in a single one ? 

Dr. Clements. Not in a single one. 

Senator Bath. Is that legal ? You cannot get this drug out on the 
street, in that kind of setting. 

Dr. Clements. The Nurse Practice Act and the Pharmacy Act 
varies tremendously from State to State and is, I am afraid, often 
ignored in State institutions. 

Senator Bath. So in essence you are saying, in many cases, that 
drugs are administered in this fashion despite the fact that the law pro- 
hibits this type of practice. 

Dr. Clements. That is correct, and again I can cite many instances 
of "prn" orders being given for controlled drugs and left totally up to 
the discretion of untrained ward attendants to give this drug and to 
decide in fact when it shall be given. And what is even worse, this 
attendant may not have been on that ward ever before in his life and 
may not have ever even seen his child before in his life, but the child 
does something that the attendant does not like or is not easily toler- 
ated by the attendant, and he gets the pill. 



114 

Senator Bath. Let us explore exactly how these circumstances hap- 
pen. We are not trying to point the finger of blame at anybody, or any 
class of people, except perhaps on society, generally, for tolerating these 
conditions. 

Let us assume the kind of environment you described earlier Doctor, 
where you have 30 to 90 retarded persons in an environment that pro- 
vokes certain kinds of what might be called, outside of that environ- 
ment, an abnormal reaction, However inside of that environment it 
could be an environment-inducted reaction. Let us further presmne 
that the personnel assigned to maintain this number of individuals is 
totally inadequate — where you have one person assigned to shepherd 
and maintain 60 to 90 people. I think that is asking something that is 
almost impossible. 

Thus, when that person observes a reaction that is causing him or 
her some trouble, they ask that the prn prescription be f ulfillled to still 
that person. Then the attendant's normal reaction would be to say, 
"Well, I did not have any trouble with that person again, so it did, 
indeed, accomplish its purpose." 

This hypothetical situation is not very much removed from the 
kind of horror stories that we heard emanating from some of our 
juvenile institutions for mentally retarded? There, to keep a child 
from bothering the custodian, he or she was physically tied or hand- 
cuffed to the bed. 

INSTITUTIONAL MENTALLY RETARDED "CARE" 

Dr. Clements. This happens every day in the institutions for the 
mentally retarded. I was just talking about pills earlier. I have seen 
individuals tied in bed for as long as 2 years, 22 out of 24 hours every 
day. That for one episode of head-banging. I have seen individuals 
locked in seclusion for as long as 7 years with the only furnishing in 
that room a can in which the individual could take care of his toileting 
needs, if he was able to manage it. 

Senator Bayh. Were those individuals, who were put in that kind 
of confinement, likely to do damage to themselves or their fellow 
inmates ? 

Dr. Clements. Oh, they could have been, or they could have been 
exhibiting some kind of behavior that was not liked by the keepers. 

Senator Bayh. Lock them up, tie them up, handcuff them, or drug 
them? 

Dr. Clements. Yes. 

Senator Bayh. That is hardly civilized treatment, particularly with 
mental retardation. 

Dr. Clements. Well, many institutions unfortunately in the United 
States are hardly civilized. This is well documented. There are many, 
many cases filed in court at the present time and all of this has been 
very clearly documented. 

There is not enough space, not enough clothing, not enough person- 
nel, not enough of anything to properly treat. You cannot even care 
for the individuals in the United States today, much less habilitate 
them. 

Senator Bayh. We had a representative of one of Washington's 
most prestigious law firms testify earlier. In a study they conducted, 



115 

they pointed out that phenothiazines are widely administered to non- 
psychotic retarded persons — half of whom are children. Also, that the 
scientific data did not support the need for this particular type of 
drug. 

Is that a common assessment, would you say, from your experience ? 

Dr. Clements. It is common. Would you like to see some of the 
figures I have taken from actual records in institutions ? 

Senator Bath. Yes, I would, Doctor. 

Dr. Clements. All right, some of these figures I am giving you I 
just list as units I, II, III, IV, V, rather than to identify the place 
where I collected this information. 

Now, these are from units of different institutions all over the coun- 
try, and I do not wish to identify in most cases the institution because 
many of these are cases awaiting litigation, and I do not think it 
would be quite right to identify them. 

In one, 42 percent of the residents were on tranquilizers. In another, 
64 percent of residents were on tranquilizers; another 78 percent, 
another 80 percent. 

Senator Bath. Eighty percent ? 

Dr. Clements. Eighty percent ; another 27 percent of residents on 
tranquilizers. Now, interestingly, this was a nonambulatory unit — 
that is, the individual was not able to get up and run about or cause 
any problem. 

Sixty- four percent of residents on tranquilizers in another; 65 per- 
cent in another ; 54 percent in another. Here is another one : 25 per- 
cent, and again that was a nonambulatory unit, where people could not 
get up and move about. 

Senator Bath. Why would you put 25 percent of a nonambulatory 
ward on tranquilizers? 

Dr. Clements. Well, I would have to come back and say, why put 
70 percent of the ambulatory, but 25 percent were probably placed be- 
cause they were "not sleeping well at night, or crying, or thrashing 
about in bed." Again, why do they not sleep well at night? They are in 
bed 24 hours a day. They are lying there in bed, and that is the reason. 

SIX TRANQUILIZERS AS SINGLE DOSAGE 

I saw one institution — and this is well documented in a court 
order — that 70 percent of all of the residents out of a total of 750 in 
that institution were on tranquilizers, and generally multiple types of 
tranquilizers, and it was not uncommon for me to find a drug order for 
as many as six tranquilizers given simultaneously to the residents in 
that institution. 

Senator Bath. Were children involved ? 

Dr. Clements. Most of these were children, yes. 

Senator Bath. Most of them children ! 

Dr. Clements. Yes. 

I saw another institution where the most common order on any of 
the charts in this entire institution was 15 milligrams of phenobarbitol 
three times a day for masturbation. 

Senator Bath. In addition to stopping masturbation, what other 
impact would that have on a child ? 



116 

Dr. Clements. Fifteen milligrams of phenobarbitol three times a 
day would have little impact on anyone for anything. 

Senator Bath. No other impact? 

Dr. Clements. No, sir. It is too small a dose. They were not even 
able to give a proper dose, even if they were going to give it without 
good reason. 

Senator Bath. In other words, you would not accomplish the pur- 
pose you are trying to accomplish. You just are giving sort of a rote 
reaction ? 

Dr. Clements. That is correct. 

Senator Bath. If in doubt, sedate ? 

Dr. Clements. You see, there is a major problem of education and 
communication with physicians in institutions for the mentally re- 
tarded. Many institutions do not have fully licensed physicians. Some 
of the physicians are not licensed to practice medicine anywhere. Even 
if they have an institutional license, this means they cannot practice 
outside of that institution. By implication they are not worthy to prac- 
tice on regular citizens. This is not an uncommon thing. 

language and lack of education confuse communication 

The other problem I have seen — horrible communication problems 
in institutions. I know of one very large institution where a large 
number of the nurses speak one foreign language, a large number of 
the physicians speak another foreign language, and unfortunately 
it is not the same foreign language, so they cannot even communicate 
together in a foreign language in the United States. 

The attendants who have to take orders and give instructions to 
both have on the average, generously, a ninth grade academic level, 
and there is an absolutely fantastic system of sign language in this 
institution of a physician communicating to a nurse or to an attend- 
ant, and they in turn communicating back with sign language because 
none of these people understand the other's verbal language. Can you 
imagine taking a telephone order in a situation like this? And tele- 
phone orders are given. 

And again this is not an ucommon situation, unfortunately. 

Senator Bath. Let me ask you a little broader general question. 
The science of coping with mental retardation has accomplished sig- 
nificant progress, I think, over the last several years. Or, perhaps, a 
better thought is that we have risen above the idea of total futility 
that once a mentally retarded child was born, that child could never 
serve any useful purpose. 

Is it fair to say that — in this one institution where you had many 
children, 70 percent of whom were sedated — if they had been treated 
with the best that medical science and psychiatry could have pre- 
scribed, those children could have escaped their chains of mental 
retardation and lived a useful life? 

Dr. Clements. If the individuals in that institution had not been 
oversedated by tranquilizing drugs, I have no doubt but what every 
individual in that institution with proper treatment could have made 
substantial progress. 

Senator Bath. Every ? 



117 

Dr. Clements. Every individual. 

Senator Bayii. That is very disheartening. 

Dr. Clements. Another very disheartening thing — when one is 
trying to find out what is going on in these institutions — is when one 
examines the records. Almost inevitably there is no documented reason 
given for the placement of individuals on tranquil izing drugs. Now, 
I am speaking only for institutions for the mentally retarded. 

Again, a situation that is not this uncommon, but I would like to 
relate to you goes back to an experience I had in an institution in 
this country not long ago. I went over to a unit and asked to see the 
records. In looking at physicians' orders, according to the physician's 
order sheet, every individual on that unit was on tranquilizing drugs. 
In talking to the ward staff, they said this was not true, that the real 
orders were two floors below on another unit. 

So I went two floors below on the other unit to take a look, and 
there were two sets of records there. So, in essence, what I ended up 
dealing with was three sets of records for the same people. 

Now, I could not understand what was going on, but think of the 
poor ward attendant who every time it came time to pass out pills, 
this poor guy had to make a decision about which one of these records 
shall I use. Of course, it did give him considerable leeway, and the 
attendants on this same unit told me that they brought in drugs from 
outside of the institution to give to the patients when they could not 
control them otherwise, and I know for a fact that there were drugs 
on that unit that were not from that institution because certain of the 
drugs that I saw on the unit were not even carried by the pharmacy 
that was operated by that institution. 

Senator Bayii. How did they get those pills ? 

Dr. Clements. The attendants brought them in. 

Senator Bayh. How did the attendants get them ? 

Dr. Clements. I assume they are quite easy to get. I do not know 
how they got them, but they showed me where they kept them, behind 
a radiator cover on the unit. 

Senator Bayh. Let me ask you another question at this time, Doctor. 
I understand that you have had a project called Cottage 17. Could 
you give us a picture of what can happen when drugs are reduced or 
eliminated as far as a response to patients is concerned ? 

COTTAGE 17 PROJECT 

Dr. Clements. All right; Cottage 17 is a cottage of the Georgia 
Retardation Center, and most of these individuals on admission to this 
cottage I would say are early teenage or young adult, in that age range. 
Many of them come from homes where they have never had any formal 
training of any kind. They have been excluded from the public schools 
and other public programs. Generally, they are severely to profoundly 
retarded. Most of them have no self-help skills — that is, they cannot 
bathe themselves, feed themselves, dress themselves, or in essence 
cannot take care of their own bodily needs. 

A very high percentage of these individuals come in on drugs, and 
at times unfortunately physicians who work there placed additional 
ones on drugs. I have been so concerned about this in that I am requir- 



118 

ing a myriad of information now before I will allow physicians to 
place individuals on drugs in this unit. 

What we were seeing when these individuals came in was, they were 
lying about on the floor doing nothing. There was no way to approach 
many individuals to give them assistance in learning self-help skills 
because many were groggy. You could not get their attention, so 
what we are doing now is gradually reducing these drugs, noting 
prior to the time we reduce them what their behavior was like, the 
incidence of these behaviors then and while we are reducing the drugs, 
the dosage; that is, we are carefully noting the incidence of these 
behaviors, and after the drug is discontinued, we are noticing the 
incidence of these behaviors. 

What we are finding, of course, is that many were oversedated. 
Often now, where the drugs are being reduced or discontinued, we are 
able to in fact get them off the floor, teach feeding skills, dressing 
skills, social skills. Individuals that did not even relate to one another 
or to any persons are now learning to sit at tables and do simple tasks. 

This, I think, is what 3 t ou were asking me about relating to Cottage 
17. 

Senator Bayh. Are we finding out that administered drugs have 
created greater problems than they have cured ? 

Dr. Clements. Well, I am not meaning to say that there is no occa- 
sion where drug therapy should be used. That is not the case. But the 
fault of all of this lies with the fact that we are using drug therapy 
and little else. Drug therapy alone is not going to assist the patient in 
recovery. You have got to have a comprehensive program, and drug 
therapy may assist the person to control themselves long enough to 
get into this program, but drug therapy should only be used, at least 
in the nonpsychotic retarded for a short period ol time until a less 
restrictive type of program can be provided. 

DRUG THERAPY PROGRAMS ONLY FOR CONTROL 

The places that have very high percentages of drug usage are places 
essentially where there is no program except drug therapy, and drug 
therapy in that case does not become a program of assisting the indi- 
vidual toward habilitation, but is used simply to control the behavior 
of the individuals in those facilities, and that is the basis of my concern 
about the problem. 

I am further concerned — you know, it seems that we all recognize 
this, the national accrediting bodies, such as JCAH, the Joint Com- 
mission on Accrediting of Hospitals, has elaborate standards now 
which state, you shall not use drugs as a punishment. You shall not 
use drugs as simply control. The court orders all state this. 

Why is it that the courts and accrediting bodies have to tell physi- 
cians how to practice medicine? I would assume because there has 
been substantial abuse in this practice. 

Senator Bayh. Just as a generalization then, it appears there is 
remarkable similarity between reaction, response, and indeed the abuse 
when dealing with retarded children, as we found dealing with delin- 
quent children. Sometimes there is a close correlation. But, if you are 
going to get a major response from those who are retarded, or in need 
of supervision or clelinquent, you cannot just have a cavalier approach 



119 

which treats everybody alike — whether it is drugs or whatever. You 
have to zero in on the individual child, whether they are retarded or 
delinquent, if you are going to get a positive response. 

Dr. Clements. You have to have a program tailored to the needs of 
that individual. I think we would all know it would be foolish to 
assume we can go on the ward, in a general medical hospital, for 
example, and say, in this ward I am going to give everyone penicillin, 
and in this ward we are going to give everyone Stelazine, and that is 
exactly what we are doing here. It is that general. 



PREPARED STATEMENT OF DR. JAMES CLEMENTS 

I. Introduction 

It should be noted at the onset of these remarks that I am neither a phyehia- 
trist nor a psychopharmacologist. My initial formal training is in pediatrics, child 
development and mental retardation. Later training and experience is in the field 
of management. My occupation is director of a State operated residential facility 
for the mentally retarded which is also a university affiliated training center. 
Additionally, since 1964, I have been involved, rather extensively, in evaluation 
of institutional programs for the American Association on Mental Deficiency, the 
American Civil Liberties Union, the Legal Aid Society, the Children's Defense 
Fund, and the U.S. Department of Justice. My interest in and concern about the 
use and abuse of psychopharmacologic agents, which is limited to the so-called 
tranquilizers for this discussion, stems from direct observations, findings, and 
conclusions [from] of evaluations of some 15 or more institutions housing approx- 
imately 20,000 mentally retarded people. It would be difficult for me to impart to 
you the degree of concern that what I have observed may, in fact, be representa- 
tive of conditions of more than 150,000 mentally retarded people in institutions in 
the United States today. Indeed if what I have seen is an accurate representation 
of institutional conditions, it might only represent the "tip of the iceberg" phe- 
nomena as it does not take into account the millions of retarded people living out- 
side the large institutional settings in natural homes, group homes, foster homes, 
nursing homes and other living arrangements. Brief observations on my part lead 
me to suspect that the same problem does exist in these other settings. 

II. Background Information 

Before relating to you my observations on the use and misuse of tranquilizers 
in institutions for the mentally retarded, let me briefly present to you a back- 
ground on the use of and definition of the group of drugs generally referred to as 
tranquilizers. Goodman and Gilman, in The Pharmacologic Basis of Therapeutics 
[4th Ed.] state the "although interest in the psychological effects of pharmaco- 
logical agents is almost as old as mankind, the use of drugs for treatment of psy- 
chiatric disorders has become widespread only since the mid-1950's. Drags have 
found their way into the most analytically oriented practices of psychiatry and, 
in the general practice of medicine, they are used on a grand scale to change atti- 
tudes and emotions of patients. In this latter connection they are often misused. 
Nobody would deny that the overt psychotic or the severely depressed individual 
is in urgent need of therapy, and drugs now play a major role in the treatment of 
these severe disorders. Such factors as heredity, personality, social class, atti- 
tudes, and expectations, of both the patient and therapist, as well as the patient's 
environment, all contribute to the treatment outcome. Sympathy and understand- 
ing may be more important than drugs in certain types of psychiatric disorders, 
although the reverse is clearly the case in others." 

Dr. Lawrence Kolb, distinguished professor and chairman, Department of Psy- 
chiatry, College of Physicians and Surgeons, Columbia University, in his textbook 
entitled Modern Clinical Psychiatry [8th Ed.] states, "It is generally agreed that 
most of the mental disorders that afflict persons of normal intelligence may also 
afflict the mentally [retarded]. Sometimes, also [retarded people] suffer from 
psychoses of an acute transitory nature, presenting episodes of excitement with 
depression, paranoid trends, or hallucinatory experiences. The psychoses are often 
situational in origin." 



120 

III. The Pill 
The pills! What are they? 

Grollmau and Grollman in their Pharmacology and Therapeutics — A Textbook 
for Students and Practitioners of Medicine and Its Allied Professions [7th Ed.] 
define the tranquilizing drugs "which comprise the major tranquilizers [are] 
used in the management of disturbed, particularly schizophrenic, patients and 
the minor tranquilizers [are] used to quiet agitated and neurotic individuals." 
In describing the major tranquilizers they state that ''the peace of mind" induced 
by these drugs * * * described is a psychological state which may also be elicited 
by any drug which alleviates pain, discomfort, or anxiety. The term "tranquilizer" 
accordingly lacks any specific pharmacological connotation and is applicable to 
almost every drug used in disease but by general use it has come to denote the 
group of psychotherapeutic agents which exert a central sympathetic suppresent 
action. They have found wide application in the care of psychotic patients and 
the medical management of milder forms of neuroses * * * in nervous or anxious 
patients, the tranquilizing drugs often produce "a detached serenity without 
clouding the consciousness or depressing the mental faculties." As for the so-called 
minor tranquilizers, "they are used for suppressing the less severe manifestations 
of anxiety and tension, for controlling mild degrees of emotional upset in psycho- 
neurosis * * * none of the minor tranquilizers is effective in patients with neu- 
roses. All tend to induce drowsiness and their use is accompanied at times, with 
other side effects. Physical or psychic dependence may follow their use * * *" 

IV. Who Prescribes the Pills? 

So much for defining the parameters of the types of medication relating to 
my concern. Of greater concern to me is the initiator of the prescription for these 
medications — the physicians. Without question some practitioners in institutions 
for the mentally retarded today are not licensed physicians or have only an 
institutional license — that is, they cannot practice outside the institution itself. 
Of still greater concern is the lack of knowledge of the effects and hazards of 
these medications on the part of the best trained physicians practicing in these 
facilities, or those practicing elsewhere for that matter. Many physicians were 
trained prior to the general use of these drugs. Less than half of the physicians 
trained in the United States today get an adequate foundation in the use of 
psychopharmacologic drugs. Let us consider for a moment the sources of in- 
formation provided a physician in training about mental retardation, behavioral 
disorders, and drug therapy related to these conditions. The Textbook of Pedi- 
atrics (9th edition) by Nelson, Vaughan, and McKay is probably the most widely 
used source of medical information concerning children in the United States. In 
this textbook of 1,589 pages, 9 pages are devoted to mental retardation. May I 
quote from one of the introductory paragraphs from the chapter on Mental Re- 
tardation : "Mental retardation may well be the most handicapping of all child- 
hood disorders. There are only four other significantly disabling conditions — 
mental illness, cancer, heart disease and arthritis — that have a higher prevalence, 
but each of these is in greatest measure a problem of adult life. It is estimated 
that 3 percent of the population may be identified as mentally retarded at some 
point in their lives." Eight pages of this previously referenced text are devoted 
to emotional and behavioral disorders. Much of the information on treatment 
of emotional and behavioral disorders is appropriately devoted to discussion of 
alteration of the environment. The one paragraph concerning drugs states "the 
prescription of drugs to lessen anxiety will help most when they are a part of a 
comprehensive approach * * * it is probably best for the physician to become 
acquainted with one or two of the tranquilizers and use those exclusively." 

What about the physician already practicing, outside of a medical school 
complex? Where does he get his information? Some comes from the myriad of 
medical journals reporting results of research and experience — the volume 
of these journals is formidable and there is no way a busy physician can even 
peruse the majority of these. In our library at the Georgia Retardation Center 
we have available over 200 journals most printed monthly or bimonthly. This 
represents a small percentage of the total number of such journals published. 

The Physicians' Desk Reference. (Medical Economics Company, 29th Ed.) is 
probably the most widely tised drug reference by practicing physicians. This vol- 
ume contains information on approximately 2,500 drug products. Generally for 
each drug or product listed there would be a description, action, indications, 



121 

contraindications, precautions, adverse reactions, dosage and administrations, 
and the available form of each product listed. The description of each product 
listed that has official package circulars, is described by the manufacturer of 
the product, in accord with FDA regulations. Some products listed do not have 
official package circulars. Thorazine, one of the more widely used major tran- 
quilizers, is said to be, "indicated for the control of moderate to severe agitation, 
hyperactivity or aggressiveness in disturbed children." It goes further to state 
that "Thorazine may impair mental and/or physical abilities * * * therefore cau- 
tion patients about activities requiring alertness * * *." Following this there is 
a formidable array of warnings, precautions, adverse reactions including per- 
sistant tardative dyskinesis. Valium, one of the minor tranquilizers is said to be 
useful "in the symptomatic relief of tension and anxiety states resulting from 
stressful circumstances * * * (and) spasticity caused by upper motor neuron dis- 
orders (such as cerebral palsy) * * * etc." Again an impressive listing of con- 
traindications, warnings, precautions and adverse reactions are noted. While 
aspirin is not listed, one can reliably assume that, if it were, a similar array of 
indications, contraindications, warnings, precautions, and adverse reactions 
would be duly noted. 

The point is that the ultimate responsibility is thrown back onto the physician 
who may not have the time, energy, inclination, understanding or language 
comprehension to properly utilize this pill-sized encapsulation of pharmacological 
data. Factually, many physicians in institutions for the retarded are foreign 
born and trained, and have gravely limiting communication problems. One in- 
stitution with which I am quite familiar had a number of physicians who spoke 
only one foreign language, a number of nurses who spoke only one foreign 
language [unfortunately not the same foreign language as the doctors], and ward 
attendants whose average academic background was said to be the 9th grade 
level. A complex, informal system of sign language conveyed medication orders 
as well as the procedure for administration of drugs. 

One of the most effective systems of postgraduate drug education is supplied 
by drug salesmen, each representing a specific pharmaceutical house and each con- 
cerned with certain products manufactured by his particular firm. These salesmen 
are often quite well informed as to their specific products. How well are they in- 
formed about adequate diagnosis, behavioral reactions to environment, or mental 
retardation? Their primary mission is, and has to be, the sale of their product. 

V. Who Actually Administers the Pill 

One would assume that controlled drugs are administered to retarded people in 
institutions by personnel trained in administration of these drugs and by per- 
sonnel licensed to administer them. This is not the case. In all of the institutions 
that I have evaluated, not a single one required controlled drugs to be adminis- 
tered by a registered nurse. Untrained ward attendants generally do this. And 
remember, a large number of these ward attendants do not have even the equiv- 
alent of a hisrh school diploma. Some are in fact illiterate. Some are not proficient 
in the English language. 

VI. Under What Conditions Are These Drugs Given 

For those of you who have not visited a residential facility for the mentally 
retarded, let me briefly describe a typical living unit. This usually consists of a 
large dayroom, a large ward-type sleeping area, and a so-called gang bath. Pri- 
vacy is nonexistent. Due to the prevalence of terrazzo floors and tile walls the 
noise level is extremely high, making even normal (ordinary) conversation im- 
possible. Baths contain 5-6 unscreened toilets, frequently with no toilet seats 
and no toilet tissue. Sleeping areas have no effective dividers between beds — 
if any divider at all— disturbance during sleep becomes a way of life. People 
live day in and day out in large groups. They eat in groups, sleep in groups, mill 
about in dayrooms in groups, and attend to toileting in groups — all in an en- 
vironment of harsh surfaces, loud noises, and areas often permeated with the 
odors of urine and feces. Furniture is sparce or nonexistent. To compound this 
tragic situation, there is often no organized activity. A television set blares 
loudly day and night. Activity is left up to the individual resident's choice and 
consists of rocking, head-banging, self-mutilation, feces smearing, masturbation, 
etc. Furthermore, there are not sufficient personnel to attend to even the bodily 



122 

needs of the residents. Even if there were adequate and sufficient space to or- 
ganize therapeutic programs for small groups of residents, there are not suffi- 
cient personnel in quality and quantity to do the job. It is not unusual in these 
situations for one untrained and unskilled employee to have to attend to the 
bathing, feeding, toileting, and all needs of as many as 30 residents in addition 
to administering medications to them. Not only are regularly scheduled drugs 
given by people who may be totally unknowledgeable of dosages, contraindica- 
tions, side effects, etc., but it is not unusual for PRN orders to be left to their dis- 
cretion. In one unit I visited recently, which housed approximately 30 severely 
retarded nonambulatory residents, eight of these residents had standing PRN 
orders for drugs like Compazine, Mellaril, Valium and VistariL 

It is not uncommon to witness medications being administered to residents 
[who were] being forcefully restrained on the floor, or to nonambulatory residents 
lying flat on their backs in bed. The extremely depriving, nonstimulating envi- 
ronments described above do in fact foster the very behaviors that drugs are 
given to alleviate such situational disorders as sleep disorders, head-rolling, 
head-rocking, head-banging, picking, pulling and rubbing habits, teeth grind- 
ing, masturbation and disruptive behavior — frequently the target for drug con- 
trol — are due in part to the general environment in which drug therapy is being 
utilized. Nelson's Textbook of Pediatrics, previously referred to, describes the 
treatment of choice for these conditions as correcting the environmental situa- 
tion. It does appear therefore, that a condition is being altered by medication 
inappropriately when the condition is caused and/or accentuated by an alterable 
environmental situation. 

VII. Is the Use of Tranquilizers in Institutions for the Mentat.lt Retarded 
a Problem of Sufficient Magnitude to Warrant Concern 

Of the institutions that I have surveyed, the following figures were taken from 
actual records on residential units. For simplicity purposes I will denote these 
units by a simple arabic number rather than by the actual name or number. 

Unit 1 — 42 percent of residents on tranquilizers. 

Unit 2 — 64 percent of residents on tranquilizers. 

Unit 3 — 78 percent of residents on tranquilizers. 

Unit 4 — 80 percent of residents on tranquilizers. 

Unit £5 — 27 percent of residents on tranquilizers [interestingly this was a non- 
ambulatory unit]. 

Unit 6 — 64 percent of residents on tranquilizers. 

Unit 7 — 65 percent of residents on tranquilizers. 

Unit 8 — 54 percent of residents on tranquilizers. 

Unit 9 — 25 percent of residents on tranquilizers [another nonambulatory unit]. 

Unit 10 — 50 percent of residents on tranquilizers. 

In one institution 70 percent of all residents [of 750 total] were taking tran- 
quilizers. 

In another institution 53.9 percent of all residents were regularly receiving 
tranquilizing drugs. In one institution the most common drug order encountered 
was Phenobarbital 5 mgm tf.d. for masturbation. 

Inadequate and inaccurate records in many institutions make an accurate 
assessment difficult if not impossible. I will recall one unit I visited which housed 
10 retarded people. In reviewing the physicians orders, I noted that all 10 resi- 
dents were on tranquilizers. Upon questioning the ward personnel, I was told 
that these were not "the real records," that "the real records are kept two 
floors below on another unit." After going the two floors below I discovered two 
additional sets of drug orders, none of which were the same. In essence there were 
three sets of different orders. Each ward attendant, assigned to administering 
drugs had to decide which set of orders to use. The problem was further com- 
pounded, I am told, by the ward attendants bringing in drugs from outside the 
facility to administer to difficult to manage residents. 

VIII. A Problem of National Concern 

During the last 3 years numerous right to treatment cases have been filed in 
Federal court. I personally have been involved in eight of these. The excessive 
use of tranquilizing drugs has been a portion of the complaint of all the cases 
about which I have had a personal involvement, in each case so far litigated the 



123 

court has set standards for drug administration. The order in Wyatt v. Stlckney 
[Partlow State School and Hospital] states : 

A. No medication shall be administered unless at the written order of a 
physician. 

B. Notation of each individual's medication shall be kept in his medical 
records [standard 14 (i) supra]. At least weekly the attending physician 
shall review the drug regimen of each resident under his care. All prescrip- 
tions shall be written with a termination date, which shall not exceed 30 
days. 

C. Residents shall have a right to be free from unnecessary or excessive 
medication. The resident's records shall state the effects of psychoactive 
medication on the patient. When dosages of such are changed or other psycho- 
active medications are prescribed, notation shall be made in the resident's 
record concerning the effect of the new medication or new dosages and the 
behavior changes, if any, which occur. 

D. Medication shall not be used as punishment, for the convenience of 
staff, as a substitute for a habilitation program, or in quantities that inter- 
fere with the resident's habilitation program. 

E. Pharmacy services at the institution shall be directed by a profes- 
sionally competent pharmacist licensed to practice in the State of Alabama. 
Such pharmacist shall be a graduate of a school of pharmacy accredited by 
the American Council on Pharmaceutical Education. Appropriate officials of 
the institution, at their option, may hire such a pharmacist or pharmacists 
full time or, in lieu thereof, contract with outside pharmacists. 

F. Whether employed full time or on a contract basis, the pharmacist shall 
perform duties which include but are not limited to the following : 

1. Receiving the original, or direct copy, of the physician's drug treat- 
ment orders; 

2. Reviewing the drug regimen, and any changes, for potentially 
adverse reactions, allergies, interactions, contraindications, rationality, 
and laboratory test modifications and advising the physician of any 
recommended changes, with reasons and with an alternate drug regimen ; 

3. Maintaining for each resident an individual record of all medica- 
tions [prescription and nonprescription] dispensed, including quantities 
and frequency of refills ; 

4. Participating, as appropriate, in the continuing interdisciplinary 
evaluation of individual residents for the purpose of initiation, monitor- 
ing, and followup of individualized habilitation programs. 

G. Only appropriately trained staff shall be allowed to administer drugs. 
In the consent judgment [Parisi v. Carey] standards for medication prescrip- 
tion, pharmacy services, drug administration, and drug storage included the 

following : 

1. No prescription medication shall be administered except upon order 
of a physician. Such orders shall be confirmed in writing by a physician 
as promptly as possible, within 24 hours. 

2. Notation of each individual's medication shall be kept in his medi- 
cal records. At least weekly the attending physician shall review the 
drug regimen of each resident under his care. All prescriptions shall be 
written with a termination date, which shall not exceed 30 days. The 
chief medical or pharmacological professional shall provide an annual 
statement of the volume and frequency of drugs administered, by type 
and condition of resident, 

3. Residents shall have a right to be free from unnecessary or exces- 
sive medication. The resident's records shall state the effects of psycho- 
active medication on the resident. When dosages of psychoactive medi- 
cations are changed or other psychoactive medications are prescribed, 
a notation shall be made in the resident's record concerning the effect 
of the new medication or new dosages and the behavior changes, if any, 
which occur. 

4. Medication shall not be used as punishment, for the convenience 
of staff, as a substitute for program, or in quantities that interfere with 
the resident's program. 

5. Pharmacy services at the institution shall be directed by a profes- 
sionally competent and licensed pharmacist. Such pharmacist shall be 
a graduate of a school of pharmacy accredited by the American Council 



124 

on Pharmaceutical Education. Appropriate officials of the institution, 
at their option, may hire such a pharmacist or pharmacists full time or, 
in lieu thereof, contract with outside pharmacists. 

6. Whether employed full time or on a contract basis, the pharmacist 
shall perform duties which include but are not limited to the following : 

a. Receiving the original, or direct copy, of the physician's drug 
treatment order ; 

b. Reviewing the drug regimen, and any changes, for potentially 
adverse reactions, allergies, interactions, contraindications, ration- 
ality, and laboratory test modifications, and advising the physician 
of any recommended changes, with reasons and with an alternate 
drug regimen; 

c. Maintaining for each resident an individual record of all medi- 
cations [prescription and nonprescription] dispensed, including 
quantities and frequency of refills. 

7. Only appropriately trained staff shall be allowed to administer 
drugs. Persons administering oral medications shall ensure that they are 
swallowed by the resident. 

8. Written policies and procedures that govern the safe administration 
and handling of all drugs shall be developed by the responsible phar- 
macist, physician, nurse, and other professional staff. 

a. The compounding, packaging, labeling, and dispensing of drugs, 
including samples and investigational drugs, shall be done by the 
pharmacist, or under his direct supervision, with proper controls 
and records. Each drug shall be identified up to the point of admin- 
istration. Procedures shall be established for obtaining drugs when 
the pharmacy is closed. 

b. There shall be a written policy regarding the administration 
of all drugs used by the residents, including those not specifically 
prescribed by the attending practitioner. There shall be a written 
policy regarding the routine of drug administration, including 
standardization of abbreviations indicating dose schedules. Medica- 
tions shall not be used by any resident other than the one for whom 
they were issued. 

9. Drugs shall be stored under proper conditions of sanitation, temper- 
ature, light, moisture, ventilation, segregation and security. 

a. All drugs shall be kept under lock and key except when author- 
ized personnel are in attendance. 

b. The security requirements of Federal and State laws shall be 
satisfied in storerooms, pharmacies, and living units. 

c. Poisons, drugs used externally, and drugs taken internally shall 
be stored on separate shelves or in separate cabinets, at all locations. 

d. Medications that are stored in a refrigerator containing things 
other than drugs shall be kept in a separate compartment with 
proper security. 

e. A perpetual inventory shall be maintained of each narcotic 
drug in the pharmacy, and each unit in which such drugs are kept, 
and inventory records shall show the quantities of receipts and 
issues and the person to whom issued or administered. 

f . If there is a drug storeroom separate from the pharmacy, there 
shall be a perpetual inventory of receipts and issues of all drugs by 
such storeroom. . 

10. Discontinued and outdated drugs, and containers with worn, illegi- 
ble, or missing labels, shall be returned to the pharmacy for proper 
disposition. ' 

11. Medication errors and drug reactions shall be recorded and reported 
immediately to the practitioner who ordered the drug. 

It is alarming and distressing when it becomes necessary for a court to explain 
the proper practice of medicine to the medical professor. 

[Certain] Nationally recognized standards now make mention of the proper 
and/or improper uses of psychopharmacologic agents. I interpret this again, as 
a growing national concern about the misuse of these agents. In its Standard for 
Residential Facilities for the Mentally Retarded [5th printing, April, 197o] the 
Joint Commission on Accreditation of Hospitals, accreditation council for facili- 
ties for the mentally retarded states : 



125 

"2.1.8.8 Medication shall not be used excessively, as punishment, for the con- 
venience of staff, as a substitute for programs, or in quantities that interfere 
with a resident's habilitation program. 

"2.1.8.8.1 Psychotropic or behavior modifying drugs shall be used only as 
an integral part of an individual program plan that is designed by an interdis- 
ciplinary team to lead to a less restrictive way of managing, and ultimately to 
the elimination of, the behaviors for which the drugs are employed. 

"2.1.8.8.1.1 The program plan must specify the behavior to be modified, a time- 
limited prescription by a licensed physician, and the data that are to be collected 
in order to assess progress toward the treatment objective." 

Written in the regulations to be followed by intermediate care facilities for 
the mentally retarded licensed to receive title XIX funds there is also a standard 
relating to the use of psychotropic medication : 

"Chemical restraints shall not be used excessively, as punishment, for con- 
venience of staff, as a substitute for program, or in quantities that interfere 
with a resident's habilitation program." 

Recently I wrote to a number of professional colleagues — both physicians and 
nonphysicians — in the field of mental retardation asking their opinion on the 
use of psychopharmacologic drugs in institutions for the mentally retarded. Of 
the 25 replies, only one felt there was no need for concern. You might be interested 
in some of their replies : 

'"I am aware of the gross misuse of such drugs which has existed in many 
institutions for many years." — A State commissioner for mental retardation. 

"As a member of the board of one of our State institutions, I seem to be up 
against a stonewall in persuading administrators to get on top of the drug 
situation. It is a terrible situation, I am shocked at the irresponsibility of my 
professional colleagues." — from a past president of the American Association on 
Mental Deficiency. 

"In all too many instances drugs are being used as a last resort to compen- 
sate for inadequate programing. Abuse is not in using tranquilizers [per se] but 
in permitting the environment without sufficient staff and programing." — from 
a former president of the National Association of Superintendents of Public 
Residential Facilities for the Mentally Retarded. 

"Without a doubt, wholesale and indiscriminate use of major tranquilizers has 
been used to control institutionalized mentally retarded persons, and, all too 
often, because insufficient staff made this means of management necessary." — A 
staff physician in an institution for the mentally retarded. 

"It is apparent that too often these drugs are overused and abuses occur. Fur- 
ther, all too often these drugs are used without proper review." — The super- 
intendent of an institution for the mentally retarded. 

"We become increasingly concerned about the misuse of tranquilizing drugs in 
the way it interferes with our teaching programs." — A university professor. 

"People just don't realize how flagrantly abusive drug treatment has become in 
State schools." — A former State Commissioner of Mental Retardation. 

"There is no dobut that these drugs are misused and very often because of in- 
adequate staffiing and programing." — From a medical consultant to a State De- 
partment of Mental Health and Mental Retardation. 

One last personal comment. — Recently I spoke with the National Association of 
Superintendents of Public Residential Facilities for the Mentally Retarded at it's 
annual meeting about drug problems in institutions. Following my presentation 
one nonmedical superintendent told me how grateful he was for a staff of ex- 
cellent physicians and because he had such an excellent staff he knew he had no 
abuses of drugs in the institution he directed. 

I suggested to him that he look at a few records himself before he became 
overly confident. He called me later to report that the first 30 records he examined 
accounted for 3,000 tablets of Thorazine in the last 30 days. 

IX. Beginning a Small Attack on a Large Problem 

It would be naive to assume that a few regulations relating to proper use of 
drugs would give adequate relief to so large a problem. Ultimate solutions in- 
volve better medical education relations to mental retardation, improvement of 
institutional environments, adequate quality and quantity of staff, development 
of proper individualized programs for people in institutions, providing adequate 
procedural safeguards, as well as providing massive systems of community pro- 



83-303—77 10 



126 

grams and community living arrangements for mentally retarded people in the 
least restrictive environment possible. 

(But what can be done for those individuals residing [appropriately and inappro- 
priately] in institutional settings? I would suggest, as a beginning, the following: 

1. Before any psychopharmacologic agent is prescribed : 

A. The behavior or behaviors that are preventing a person from taking 
advantage of therapeutic programs available should be clearly targeted and 
documented by the attending physician ; 

B. The frequency of these behaviors should be carefully observed and accu- 
rately recorded [for example destructive behaviors occurring only rarely 
and intermittantly should not be treated with drugs] ; 

C. Potential harmful effects of any drug should be carefully weighed 
against harmful effects of the target behavior, and drugs should be used 
ouly when harmful effect of the target behavior clearly outweigh potential 
harm of the drug [such information should be clearly documented]. 

2. A time-limited prescription should be written, and reviewed; 

3. During the course of drug treatment : 

A. The incidence of the target behaviors should be documented ; 

B. If the incidence of the occurrence of the target behavior does not de- 
crease to a tolerable degree, allowing the individual to participate in a less 
restrictive form of management, the drug should be discontinued. 

4. The program plan, of which the drug treatment is but one part, should spec- 
ify the time in which the problem condition is to be ameliorated. 

5. So called drug holidays, described as the gradual diminishing of dosage and 
ultimate discontinuation of the drug, should be part of every program plan for 
use of psychotropic medication. 

6. Psychotropic drugs should be prescribed only by fully licensed physicians : 

7. Psychotropic drugs should be administered only by registered and licensed 
nurses ; 

8. Residents of legal age who are mentally competent to understand the pur- 
pose and nature of the treatment should participate in the plan for drug therapy, 
give their permission for such treatment, and be allowed to discontinue the treat- 
ment under medical supervision at any time ; 

9. Parents and/or legal guardians should be informed, in writing, of drugs pre- 
scribed, their expected benefits, and possible hazards and if the resident is under 
legal age and/or incompetent, they should be allowed to refuse treatment on his 
behalf. 

X. Summary 

Mr. Chairman, I recognize that my remarks have been somewhat disjointed and 
sketchy. In conclusion let me say that there is a massive problem of drug misuse 
and abuse in institutions for the retarded throughout this Nation. The problem 
is multifaceted. It is due to many interrelating factors. Among those are : 

1. Inadequate knowledge of the effects of psychotropic medication as an ad- 
junct to the comprehensive treatment of mentally retarded people ; 

2. Physicians generally are not properly prepared, during their training, con- 
cerning mental retardation in general and specifically about psychopharmacology ; 

3. Medical staffing in institutions for the mentally retarded is inadequate both 
in quality and quantity ; 

4. Environments in most institutions for the mentally retarded, are counter- 
therapeutic ; 

5. Psychotropic drugs are being used in lieu of adequate staff and programs ; 

6. Existing national standards used by accrediting bodies are inadequate for 
proper drug control ; and, 

7. Certain procedural steps, if utilized, will assist in controlling abuse of these 
drugs but will not, unless used in concert with other habilitative measures, 
eliminate this problem. 



Senator Bayi-i. Thank you Doctor, very much. I really appreciate 
your contribution. You obviously have studied this problem in some 
detail. 

Dr. Wendel, you have been very patient. Thank you for your pres- 
ence here. 



127 

STATEMENT OF DR. HERBERT A. WENDELL, ASSOCIATE PROFES- 
SOR OF PHARMACOLOGY, AND HEAD, DIVISION OF CLINICAL 
PHARMACOLOGY, UNIVERSITY OF OREGON, PORTLAND, OREG. 

Dr. Wendel. Senator, I have prepared several pages of notes, but I 
do not think it would make sense to read them because much of what I 
have to say would be repetitive, and I would prefer primarily to com- 
ment on some of the issues and questions which have come up this 
morning in the testimony of these former patients, as well as Dr. Kauf- 
man and Dr. Clements, and submit a prepared statement for the 
record. 1 

Briefly about my background, I am a medical doctor and phar- 
macologist. I should like to emphasize that I do not call myself or con- 
sider myself a psychopharmacologist as I read in your news releases. 
I am a clinical pharmacologist with primary interest in adverse or 
toxicologic effects. 

I am holding a position of associate professor of pharmacology and 
head of the Division of Clinical Pharmacology at the Health Sciences 
Center of the University of Oregon in Portland, Oregon. 

I have been certified as an internist in Germany and have been active 
in drug research. I have been teaching pharmacology and been close 
to the pharmaceutical industry for 12 years, where I worked for 4 years 
with a major manufacturer of antipsychotic drugs, Smith, Kline and 
French Laboratories, and in academic insttiutions for 17 years. 

Now, I made some notes on the questions and previous testimony, so 
I am going to pick some up and would like to comment on them as I 
see them from a pharmacological viewpoint. 

CENTRAL PROBLEM — MISPRESCRIBING OP DRUGS 

The central problem here, as I see it ^J s misprescribing of jihese 
drugs . 1 woiua like to repeat what Dr. Kaufman said. These antipsy- 
chotic drugs or major tranquilizers are extremely valuable drugs if 
prescribed properly, and properly means, if they are used in those sit- 
uations which have a scientifically proven basis, and this would be 
primarily schizophrenia — actually, the proper name for these drugs 
"tranquilizer" is a very unfortunate term because it is confusing. It 
does not say anything about the specific effects of these drugs, and it 
infers that they are similar to another group of drugs which are also 
called tranquilizers. That is the Librium- Valium type. 

Both of these are pharmacologically and clinically entirely differ- 
ent drugs. Both act on the brain, but in their pharmacological prop- 
erties, they are quite distinct. The best name of these drugs, the Thora- 
zine type, would be antischizophrenic drugs, because that would clearly 
indicate a certain disease or group of diseases where they are really 
effective and have extreme value. 

Senator Bath. In other words, you would say that barbiturates 
would not, in any way, be used to deal with those problems ? 

Dr. Wendel. No, not at all. In pharmacology we call the major tran- 
quilizers antipsychotic or antischizophrenic drugs. These comprise the 

1 See p. 130. 



128 

phenothiazines whose prototype is Thorazine, and several other groups 
which pharmacologically are similar. These drugs, when they appeared 
about 20 years ago, superseded the barbiturates. Until then — Dr. Cle- 
ments may be able to confirm this — in psychiatry or mental institu- 
tions, barbiturates were the predominant medicines. They had the dis- 
advantage of putting patients to sleep, and if a person is asleep, he 
still needs custodial care. He has to be watched and has to be cared for. 

There is a tremendous advantage of the antischizophrenic drugs; 
they have some degree of selective suppression of the symptoms of 
psychosis, that is, schizophrenia, toxic psychosis, senile and involu- 
tional psychosis, and the manic phase of manic-depressive disease, 
without causing sleep. The patients stay awake. 

Senator Bayh. Do you have the addictive problem, Doctor, in 
phenothiazine ? 

Dr. Wendel. The antipsychotic drugs do not cause addiction in the 
sense we talk about addiction with narcotics, with morphine, heroin, 
barbiturates, or even amphetamines. They do not cause this compulsive 
psychic dependence, nor are there symptoms of physical dependence 
when the drugs are withdrawn after prolonged intake. 

In this context it is interesting that the antipsychotic drugs as cen- 
tral nervous system depressants do not cause euphoria as the other ad- 
dicting central nervous system depressants do, such as the narcotics, 
barbiturates, minor tranquilizers, and alcohol. 

Euphoria gives the person a feeling of heightened, increased well- 
being. If anything, these drugs cause dysphoria. Schizophrenics 
treated with these drugs get better, strikingly better, but they do not 
feel well, and nonpsychotic patients who get these drugs just for plain 
sedation or to put them to sleep feel their effect to be extremely un- 
pleasant. They feel terrible. This, I think, probably is associated with 
the fact that these drugs do not have addicting potential. 

To use these drugs as antianxiety drugs, just to relieve anxiety, is 
irrational from a pharmacological viewpoint. They may relieve anx- 
iety, but this is like using a cannon to shoot after sparrows. We have 
other quite effective antianxiety drugs the sedative-hypnotics and 
minor tranquilizers, whose toxic effects are much less severe and much 
less numerous. Therefore, the risk-benefit ratio of the antipsychotic 
drugs, if used just to relieve anxiety and tension, is highly unfavorable, 
and actually their use in this situation is irrational. 

These drugs are poor hypnotics. They do not work well in just 
putting people to sleep even though they are often prescribed for this 
reason. For inducing sleep we have a large number of well established 
hypnotic drugs, barbiturates and nonbarbiturates, available. 

SIGNIFICANCE OF CARDIOTOXIC EFFECTS 

You asked about whether phenothiazines cause heart attacks. They 
do. Fortunately, it is very rare, but it is one of these insidious, rare, 
toxic effects which took a long time before it was recognized at 
all, and today I have the impression that medical doctors and even 
pharmacologists are not fully aware of the significance of these cardio- 
toxic effects. It is a direct toxic effect on the heart. As I said it is rare, 
but the term "infarct-like" has been used to describe the sudden deaths 
of patients who receive, usually over a long term, phenothiazines. 



129 

I would like to comment on what Dr. Clements here said is his treat- 
ment in groups in institutions for the mentally retarded, that every- 
thing happens in groups, 30, 40, 60 people. There is experimental 
animal evidence and human evidence that the psychotropic drug, and 
probably more so the minor tranquilizers, the Librium- Valium type, 
have what is called paradoxical effects, depending upon the environ- 
ment of the patient. When patients are grouped together and have a 
lot of physical interaction, these drugs are likely to do the opposite 
of what they ordinarily do — they cause excitement, aggressiveness, and 
hostility. It can be demonstrated on mice and rats that their aggressive- 
ness increases when they are treated with Librium and Valium in 
groups in the same cage, whereas a single animal treated with a dose 
gets calm and sedated and has decreased activity. 

I would like to mention one other group of drugs, which has hardly 
been mentioned at all today, and these are the tricyclic antidepressants, 
such as Tofranil, Aocutil and Elavil. Their legitimate use is in the 
treatment of psychiatric depression, and here, at least in some patients, 
they increase the mood of these patients and alleviate the symptoms 
of depression. 

But they are often combined with phenothiazine type drugs. Actu- 
ally, it happens that a patient gets two phenothiazines, even though 
pharmacologically they are undistinguishable. There is no evidence 
that one could not do the job without the other. Then in addition, one 
of the tricyclic antidepressants is given. Apparently, the prescribers 
think that, because these drugs have some effect in lifting the mood of 
depressed patients, they are stimulants, that they stimulate the brain. 

But here is a confusion between alleviating psychotic depression and 
stimulating the brain, as it is done by amphetamines. These two effects 
have nothing to do with each other. 

Senator Bath. We have had some description of phenothiazines, 
particularly their excessive utilization in some of our institutions. We 
have had that particular class of drugs described as zombie juice. 

Dr. Wendel. Zombie juice? 

Senator Bath. Zombie juice, from the propensity that these drugs 
might have. 

Do you think that is a good name for them if they are prescribed to 
a general class without specific prescription ? With regard to the pro- 
pensity, they might have, to cause a person to lose control of his or her 
mental capacity. 

Dr. Wendel. I could not quite follow that. 

INDISCRIMINATE USE OF PHENOTHIAZINES . . . ZOMBIES 

Senator Bath. Would the indiscriminate application of these 
drugs — absent any specific doctor-related prescription — tend to cause 
people to lose control of their faculties, and thus tend to create the 
mental mind-set of a zombie? 

Dr. Wendel. I would think so, yes. I think it is possible based on 
their pharmacological properties. 

Senator Bath. Does this particular kind of drug inhibit or impair 
learning capacity ? 

Dr. Wendel. Yes. Everything is inhibited, slowed down. If a nor- 
mal, healthy person takes a phenothiazine, and you systematically 



130 

increase the dose, you will see a decrease in spontaneity, both physi- 
cally and mentally — that is, physical movements, the play of his 
facial muscles disappear, and intellectually and emotionally he be- 
comes flat. His responses are absent or extremely slow — he still is able 
to respond to his environment, but it is extremely slow, and with 
high doses a state of catatonia is produced, which in itself is a 
particular manifestation of schizophrenia. These people seem to be 
asleep, but respond on slight stimulation, just spoken to, they are 
awake. They are oriented, but there is no spontaneity whatsoever. 
They may listen, and they may even be able to answer very slowly 
if spoken to, but they will immediately fall back into sleep. That 
happens to a normal subject under experimental conditions. 

It has been said — and I think rightly so — that if these drugs, the 
phenothiazines and other antipsychotic drugs, would have been intro- 
duced for any disease which is less catastrophic than schizophrenia, 
they would never have been approved by the FDA and they probably 
would never have found acceptance because they are very potent 
drugs with a large number and great variety of serious toxic 
effects. 

Senator Bayh. Do you agree with the previous testimony that when 
specifically and accurately prescribed, and used according to close 
supervision, by a doctor who knows what he is doing, then these drugs 
can have a benefit for those patients diagnosed as having 
schizophrenia ? 

Dr. Wendel. Oh, definitely. 

MISUSE MAY CAUSE SYMPTOMS OF SCHIZOPHRENIA 

Senator Bayh. But, indeed, if they are administered en masse to 
those who are not schizophrenic, they may bring on the very symptoms 
of schizophrenia ? 

Dr. Wendel. Right, or other mental disturbances. I surely agree. 
These drugs are irreplaceable in the treatment of schizophrenia and 
some other psychoses. They started a revolution in psychiatry and 
the treatment of psychoses. Here, they are of great benefit. The prob- 
lem^ actually, is not the drugs. It is the misuse of the drugs, the mis- 
use in indications even where they are effective, but where we have 
other less hazardous drugs which do the same job, and may be better, 
and misuse for indications where effectiveness has no basis, no 
pharmacological or scientifically valid basis. 

Senator Bayh. You mean, they are being used as a crutch, instead 
of as a treatment? 

Dr. Wendel. Right ; and actually, they are used for nonmedical 
reasons, as we have heard this morning. These drugs are often pre- 
scribed in institutions, not for the benefit of the patient, but for the 
benefit of the family, of the institution, for the benefit of the doctors, 
of nurses, administrators. It means they are used not for medical but 
for psychosocial reasons, or economic reasons. And again, that is not 
the fault of the drugs. 



PREPARED STATEMENT OF DR. HERBERT A. WENDEL 

Mr. Chairman, members of the committee : My name is Herbert Wendel. I am 
a medical doctor and pharmacologist holding the position of Associate Professor 



131 

of Pharmacology and bead of the Division of Clinical Pharmacology at the 
University of Oregon Health Science Center in Portland, Oregon. I have been 
certified as an internist in Germany and have been active in drug research and 
the teaching of pharmacology in both pharmaceutical industry for 12 years and 
academic institutions for 17 years. At the University of Oregon Medical School, 
I am chairman of the Committee on Pharmacy and Therapeutics and a member 
of the Committee on Human Research. 

I have been asked to present to you the pharmacological basis of the use in- 
dications of psychotropic or psychotherapeutic drugs, their adverse effects, and 
their contraindications. 

Psychotropic or psychotherapeutic drugs mean drugs that act on the "mind" 
and are used to ameliorate the principal symptoms of mentally disturbed persons, 
such as tension, anxiety, depression, and the manifestation of psychosis. [Psy- 
chosis : the most severe form of mental disorders characterized by a high degree 
of eccentricity in behavior often associated with incapacity to perform the 
ordinary functions of life, complete absence of insight and failure to grasp 
external reality, and extreme inability to organize sustained socially adequate 
responses.] 

The principal site of action of psychotherapeutic drugs is the brain, although, 
as I will describe later, some of these drugs exert quite pronounced effects also 
outside the brain. 

Most psychotherapeutic drugs are central nervous system (CNS) depressants, 
i.e. they suppress, reduce, interfere with, or modify and distort brain functions. 

Among the CNS depressants we distinguish those that suppress brain func- 
tions indiscriminately or nonselective^. What looks like a preferential action on 
some brain functions is merely a matter of dose, not an intrinsic pharmacologic 
property. Increasing amounts of these drugs depress more and more parts of the 
brain, until ultimately all brain functions cease. 

These drugs are called General CNS Depressants. The principal members of 
this group are: alcohol, general anesthetics (e.g. ether, cyclopropane, halothane), 
and the sedative-hypnotics (sleep-inducing drugs) (barbiturates and nonbarbi- 
turates). I should like to emphasize that the subgroup of sedative-hypnotics in- 
cludes also what is usually called the anxiety-relieving drugs or "minor tran- 
quilizers" (meprobamate [Miltown], chlordiazepoxide [Librium], diazepam 
[Valium] and some others). 

The other division of the CNS depressant drugs comprises the Selective CNS 
Depressants. They act selectively on the brain in the sense that the usual 
therapeutic doses depress particular functions of the brain while other func- 
tions remain unaffected or are much less reduced. As the doses are increased 
more and more brain functions are impaired and selectivity vanishes. 

The subgroups comprising the category of selective CNS depressants are: 

1. Anticonvulsants (antiepileptic drugs) — Here the pharmacologic selec- 
tivity consists in a preferential suppression of those nerve centers where 
seizures originate. 

2. Strong analgesics, which are almost identical with the narcotic drugs 
(prototype morphine) — They selectively depress those parts of the brain 
that are responsible for the perception of pain. 

3. Antipsychotic drugs ("major tranquilizers") — These are the drugs 
that in a specific way alleviate the symptoms of psychoses without making 
the patient unresponsive. 

4. Antidepressants of the tricyclic type— These drugs present a para- 
doxical group. They are CNS depressants, and by their spectrum of phar- 
macological activities they resemble antipsychotic drugs, yet they seloc- 
tively lift the sadness, gloominess, hopelessness and other symptoms of de- 
pressed patients. 

The psychotropic drugs most frequently used in institutions and deserving par- 
ticular concern are the antipsychotic drugs and the tricyclic antidepressants. 
They are potent drugs with a great variety of adverse effects and are most likely 
to be overused and misused by being prescribed for trivial reasons where other 
less hazardous drugs would be equally or more effective, or for indications where 
their effectiveness is questionable. 

The antipsychotic drugs are often called tranquilizers or manor tranquilizers. 
I think this is a poor term, because it fails to indicate the specific character and 
clinical indication of these drugs. The same term is also used to designate some 
sedative-hypnotic drugs (antianxiety drugs), suggesting that the antipsychotic 



132 

drugs are just potent sedatives, while in fact we are dealing with two distinctly 
different kinds of drugs with different pharmacological properties and different 
clinical indications. Their most meaningful designation would be "antischizo- 
phrenic" drugs, because it is in the treatment of schizophrenia where their real 
value lies. It has been said that if the antipsychotic drugs had been introduced 
for treating any less catastrophic disorder than schizophrenia, they might have 
never gained acceptance and probably not have been approved by the Food and 
Drug Administration. Besides schizophrenia, antipsychotic drugs are effective 
also in involutional, senile, and toxic psychoses (except alcoholic psychosis) and 
in the manic phase of manic-depressive psychosis. The actual usage of antipsy- 
chotic drugs, however, goes way beyond these indications. They are widely pre- 
scribed as sedative drugs for patients who are not psychotic. Even if in such 
cases the drugs do relieve anxiety, their varied and hazardous adverse effects 
make the risk-benefit ratio highly unfavorable. It is like shooting flies with an 
elephant gun. Antipsychotic drugs are prescribed for inducing sleep even though 
their hypnotic efficacy is poor, and many general CNS depressant drugs are avail- 
able that are more effective and less hazardous sleep-inducers. Antipsychotic 
drugs are applied wholesale for quelling nonpsychotic excitement, to make indi- 
viduals who are difficult to deal with more tractable. While the general sedative 
action of these drugs is usually quite effective in achieving the desired calming 
effect, the absence of psychotic symptoms, the criterion for the rational use of 
the drugs, raises the suspicion that this kind of prescribing of antipsychotic 
drugs is not always solely for the patient's sake but for the benefit of the family 
or the institution, that is physicians, nurses, and administrators. In such cases, 
the drugs are not used for medical reasons based on sound pharmacological 
grounds but for manipulative psychosocial and economic reasons. 

Which are the drugs that comprise the antipsychotics? First of all, we have 
the phenotiazine drugs. About a dozen and a half antipsychotic drugs of the 
phenothiazine-type are commercially available in this country. The prototype is 
chlorpromazine (Thorazine). Other widely prescribed representatives are thiori- 
dazine (Mellaril), prochlorperazine (Compazine), trifluoperazine (Stelazine), 
and perphenazine (Trilafon). 

Phenothiazine compounds were the first antipsychotic drugs becoming avail- 
able about 20 years ago ; they are the most widely used drugs of this group and 
the most extensively studied. But they are not the only drugs with antipsychotic 
effects. 

The same pharmacologic activities and antipsychotic properties reside in at 
least three other chemical structures, and as I pointed out before, the tricyclic 
antidepressants are pharmacologically very similar to the phenothiazine anti- 
psychotics. 

Differences that do exist between these subclasses and between the individual 
drugs within each class, are merely differences in emphasis or preponderance of 
a particular effect in relation to other effects. It is difficult to see on pharmacologi- 
cal grounds why in practical usage one of the members of a subclass should exert 
different clinical effects than another member. I emphasize this point because 
many times patients are given combinations of these drugs that are unreasonable. 
Two antipsychotic drugs are often viewed as being better than one, although 
the two drugs are pharmacologically indistinguishable and clinical proof for 
such a belief is completely lacking. Withdrawn or retarded patients may simulta- 
neously be treated with a tricyclic antidepressant in the mistaken belief that this 
drug has a stimulating action. The prescribers of such combinations apparently 
confuse withdrawn behavior with depression ; they don't know that the tricyclic 
antidepressants themselves are CNS depressants that can only add to the depres- 
sion of antipsychotic drugs, and they don't know that improving the mood of 
patients with depressive disease, which the tricyclic drugs sometimes do, has 
nothing to do with stimulation of brain functions as ordinarily understood. 

Adverse Effects 

Tt is not. surprising that the phenothiazines and the other antipsychotic drnsrs 
and the tricyclic antidepressants, being potent dru<rs. also exert marked toxic 
efforts, of unusually large number of great- variety. To call them side effects, as 
many do, is to misjudge their nature and significance. They do not appear on 
the side of the therapeutic effects and play a minor role, but they are inherent 
in the pharmacological nature of these drugs and appear as an integral part 



133 

of their spectrum of biological activities. A convenient way to orient oneself 
among the multitude and variety of toxic effects is to categorize them into those 
that result from actions on the brain, those that result from actions on the 
autonomic nervous system (which controls the functions of our internal organ*, 
such as the heart, blood vessels, the gut, lung, glands, etc.), and a third group 
of miscellaneous effects on other organs throughout the body. 

A. ACTIONS ON VARIOUS PARTS OF THE BRAIN LEAD TO THE FOLLOWING 

ADVERSE EFFECTS 

1. Potentiation of depression of the brain caused by other drugs. As CNS 
depressants the antipsychotics and tricyclic antidepressants enhance the de- 
pressant effects of other CNS depressants, such as alcohol, hypnotics and minor 
tranquilizers, narcotic analygesics, general anesthetics, and the central depression 
of antihistaminics. The latter drugs are particularly important because they 
are present in many cold medicines and sleeping pills that are sold without 
prescription and used for self-treatment by the lay person. 

2. Lowering of seizure threshold. These drugs are prone to precipitate con- 
vulsions in epileptics. High doses injected into the bloodstream may produce 
convulsions also in persons who do not have epilepsy. 

3. Disturbance of various hormonal functions. By _ suppressing a region located 
o n the base of thebraiff, called the'hypot halamus7ant ipsychotlc.' drugs interfere 
withthe jhvsioTogicfll control of various hormon es necessaryf or~the normal 
fo^ctiog~paTUculaxly _of the sex organ s. The result are~juenstrual"irregularities, 
"ialTure to menstruate, milk secretion~of the breast (nonpuerperal lactation) ; 
also excessive weight gain is based on this action. 

4. Muscle disturbances. Compulsive abnormal movements, often bizarre and 
stereotyped, are common adverse effects of the phenothiazines and similar drugs. 
According to the time of their appearance during the course of drug treatment, 
two groups of such extrapyramidal motor disturbances, as they are called, are 
distinguished : 

a. Early onset during the first few days or weeks of drug administration 
is characteristic for several clinical disorders : 

(1) Acute dystonia reactions: Bizarre muscular spasms; forceful to 
violent distorted movements of the head, neck, eyes, and tongue, with 
grimacing of the face. They are particularly common in young patients 
and women. 

(2) Akathisia: Inability to sit or stand still; general restlessness; 
patients are fidgety, constantly moving up and down. Common in middle- 
aged patients and women. 

(3) Parkinsonism: Resembles Parkinson's disease with rigidity of 
the muscles, mask-like face, generalized slowing of movements, shuffling 
gait, pill-rolling movement of the fingers, fine shaking at rest, salivation. 
Older patients are particularly vulnerable. 

(4) Akinesia: Physical immobility and emotional indifference; zombie- 
like behavior. 

b. Delayed onset after many months or years characterizes the disorder 
called tardive or persistent dyskinesia. It manifests itself by stereotyped, 
rhythmical movements of the tongue, face, mouth, and jaws (tongue pro- 
fusion, puffing of the cheeks, puckering, sucking and smacking), tic-like 
movements ; purposeless irregular movements of the arms and legs, worm- 
like movements of the fingers, rocking and rhythmical swaying of the 
whole body. 

At present no effective treatment of tardive dyskinesia is known, and the 
disease persists after drug administration has been stopped indicating that the 
drugs have caused permanent brain damage. Parkinsonism and the other acute 
muscle disorders disappear after termination of drug administration. They also 
respond to the treatment with antiparkinson drugs. This fact has given rise to 
the widespread practice of automatically and routinely combining antiparkin- 
son drugs with antipsychotic drugs. It is poor drug therapy because antiparkin- 
son drugs add their own adverse effect to those of the antipsychotic drug by 
making the patient more lethargic, dizzy and confused while their shorter dura- 
tion of action does not reliably prevent the occurrence of muscle disturbances. 
Moreover, antiparkinson drugs are not necessary as long as the patient does not 
exhibit muscle disorders and may become unnecessary after a few months when 
many patients become tolerant to the adverse muscle effects. 



134 

The motor disturbances are not always recognized as toxic effects of anti- 
psychotic drugs. They have been misdiagnosed as epilepsy, encephalitis, 
meningitis, and other neurologic diseases. It took about 15 years during which 
millions of patients were treated with phenothiazines until tardive dyskinesia 
was identified as a distinct disease entity reflecting drug toxicity even though it 
is not rare. Signs of tardive dyskinesia have been reported to be observed in 30 
to 50 percent of patients who have been treated with antipsychotic drugs for 
several years. 

It is noteworthy that antipsychotic drugs and tricyclic antidepressants do not 
cause addiction in contrast to most other drugs that depress brain functions 
(narcotics, alcohol, barbiturates and other sleep producers and the minor tran- 
quilizers). Nor do they cause a feeling of heightened well-being, called euphoria 
as some other depressant drugs do. On the contrary, antipsychotic drugs cause 
dysphoria, a sense of ill-being. Schizophrenic patients do not feel well during 
antipsychotic drug treatment even though their disease gets better, and non- 
psychotic patients find these drugs distinctly unpleasant. 

B. ADVERSE EFFECTS ON THE AUTONOMIC NERVOUS SYSTEM 

1. Hypotension : Patients feel dizzy and may faint as a result of a fall in their 
blood pressure when they get up and walk around. The effect is transient and 
recovery is usually quick. But injury may result from fainting. 

2. Heart toxicity. Long-term administration of antipsychotic drugs may damage 
the heart, with abnormalities in the electrocardiogram and irregular heart beat. 
The effect is rare but may lead to death. The terms "infarct-like" death and 
"quinidine-like" depression of the heart have been used to describe this toxic 
effect. Tricyclic antidepressants are particularly dangerous in this respect. 

3. Atropine-like effects. They appear as a variety of symptoms, such as dry 
mouth, blurred vision, and constipation, and make the drugs dangerous to 
patients with glaucoma. Atropine-like adverse effects are particularly pronounced 
with Tofranil and other antidepressants, and they are inherent in antiparkinson 
drugs. Therefore, the simultaneous administration of one or two phenothiazines 
with an antidepressant and an antiparkinson drug is particularly prone to pro- 
duce manifestations resembling atropine poisoning. A drug-induced toxic psy- 
chosis may be superimposed on the primary psychiatric illness with memory 
loss, disorientation and confusion, disordered thinking, and hallucinations. 

C. MISCELLANEOUS ADVERSE EFFECTS OF PHENOTHIAZINES 

They consist in jaundice, reduction of the white blood cells, and skin reactions. 
These effects result from the individual hypersensitivity of some persons to the 
drugs and, except for very rare cases of lethal agranulocytosis, usually reverse 
after termination of drug administration. Patients on prolonged phenothiazine 
therapy may show a gray-blue discoloration of their skin and depositions of the 
drug in the eyes. 

Besides the phenothiazines, Librium and Valium are the most frequently used 
psychotherapeutic drugs in medical institutions. They belong to a group some- 
times called antianxiety drugs but commonly referred to as "tranquilizers" or 
"minor tranquilizers", a most unfortunate and confusing designation as described 
before. 

The principal medical indication of Librium and Valium are relief of anxiety 
and tension and induction of sleep. In general, these drugs are well tolerated. 
Their most common adverse effect is drowsiness and some inability to properly 
coordinate body movements (ataxia). Higher doses, particularly on injection, 
may make the patient appear like being drunk with dizziness, confusion, dis- 
ordered speech, and other symptoms of alcohol intoxication. There also may 
be a fall in blood pressure and diminished breathing. Excessive doses are likely 
to cause loss of consciousness and render the patient unarousable. But in contrast 
to poisoning by barbiturates the patients usually recover and death from anti- 
anxiety drugs is very rare. 

Occasionally Librium, Valium, and similar drugs may enhance rather than sub- 
due hostility and aggressive behavior. Patients instead of becoming calm and se- 
dated, become resentful and hateful to others, argumentative and excited to 
the point of committing acts of violence. There is a growing body of evidence that 
factors in the patient's environment, such as frustration and group interactions 



135 

as they occur in institutional settings modify the usual effects of the drugs to 
the point of what is called paradoxical rage reactions. 

Different from the phenothiazines, Librium, Valium, and other antianxiety 
drugs possess the capability of causing true addiction, a characteristic of all 
sedative-hypnotic drugs. While available experience does not indicate that 
illicit abuse of Librium and Valium is a significant public health problem, with 
prolonged intake patients may become dependent on the drugs. When the medica- 
tion is stopped they exhibit the withdrawal syndrome of barbiturate abstinence 
with agitation, quivering, delirium, sweating, and cramps. The drugs are capable 
of abuse and should be considered a looming menace to public health. It is for 
this reason that the courts have sustained the Federal Food and Drug Admin- 
istration in classifying antianxiety drugs as dangerous substances. 



Senator Bayh. Thank you, Drs. Wendel and Clements. I realize the 
inconvenience to you by these necessarily long hearings this morning ; 
but I appreciate that you have both made significant contributions in 
our efforts to investigate this drug abuse problem. TVe will attempt to 
overcome it. Thank you both very much. 

I am sure from the press coverage at these hearings there will be a 
certain amount of output generated to the public. We will reserve the 
right to include certain articles, pertinent to this hearing, as exhibits 
at this point in the record. 

[Exhibit !No. 9] 

[From the Charlotte (N.C.) Observer, Aug. 1, 1975] 
SENATE IS TOLD OF "WAREHOUSES" FOR RETARDED 

(By Gary Blonston) 

Washington. — Mental strait-jackets, chemical handcuffs, the solitary con- 
finement of the mind — those are the tools that ease the administrative burden 
of running institutions for mentally retarded children across the country. 

In florid and searing language, a group of lawyers and social scientists told a 
Senate hearing about some of those institutions Thursday, and about the drug- 
induced stupefaction of thousands of the children they are supposed to be 
helping. 

Kenneth Wooden, a Princeton, N.J. educational researcher, described "human 
warehouses" he visited in 30 states. Some are populated by children shipped out 
of other states and dosed with tranquilizers that they were fed "like candy" to 
keep them quiet and manageable. 

Wooden, whose three-year study of the problem will emerge in a book early 
next year, said "Congress should make it a felony for any doctor to administer 
phenothorazines strictly for purposes of controlling a patient. 

"We need to get tough," he said. "Congress needs to get tough." 

Sen. Birch Bayh, D-Ind., whose subcommittee is holding the hearings, seemed 
to agree. A person who puts a gun to someone else's head is violating the law, 
Bayh said, ''but if a doctor puts a needle in the vein of a child who doesn't 
need a drug, that is a legal act ... . and I think it is inexcusable." 

Gail Marker, a social worker with the Washington-based Mental Health Law 
Project, cited medical research indicating that phenothiazines, the drugs most 
used in sedating institutionalized people, have the potential for turning the 
very idea of therapeutic treatment inside out. The research suggest the drugs 
can cause permanent brain damage and reduce the learning ability of the already 
handicapped children who are forced to take them. 

David Ferleger. director of Philadelphia's Mental Patient Civil Liberties 
Project, talked about physicians, unlicensed to practice outside a state institu- 
tion, prescribing massive doses of drugs without even seeing their patients 
involved and never reviewing their condition or progress. 



136 

From the pages of an Ohio federal trial, Ferleger read the testimony of a 
doctor who said : "It's difficult for me to understand how you can help a patient 
to become a better human being when he is sleeping all the time." 

The testimony before the Senate Judiciary subcommittee on juvenile delin- 
quency was almost Dickensian in tone as it portrayed a nationwide system of 
public and private institutions, understaffed, underfinanced, underconcerned and 
dependent on drugs to simplify the drudgery of caring for the retarded and 
disturbed. 

It is hardly a new problem. Seven years ago, Dr. Ronald Lipman of the 
National Institute of Mental Health, found that more than half of the institution- 
alized mentally retarded people in the country were being maintained under 
sedation. 



[Exhibit No. 10] 

[From the Boston Christian Science Monitor, Aug. 6, 1975] 
DRUGGING AND SHDPPING OF TROUBLED CHILDREN CHALLENGED 

(By Clayton Jones) 

States that ship troubled children across state lines — and allow "massive 
overdrugging" in controlling children — are being challenged by the U.S. Justice 
Department and Congress. 

More and more incidents of "chemical handcuffing" of delinquent or emotionally 
handicapped children have been uncovered by Senate investigators recently in 
series of hearings during July and August. 

They charge several states with sending troubled children to out-of-state pri- 
vate institutions where drug treatment practices are not monitored. 

And within the past year, the Justice Department has increased the number of 
lawsuits against drug treatment misuse in juvenile and mental institutions. 

In April, Justice officials began court action to correct the treatment given 
to more than 600 Louisiana children in Texas. 

The suit challenges the alleged "forced sedation" of children— usually with 
tranquilizers — by private child-care services purchased by Louisiana in Texas. 
These "commercial jails" for dependent, neglected, retarded, and delinquent 
youths are becoming more common, say Justice officials. 

And at least 12 other lawsuits have been brought to uphold the constitutional 
rights of children and the mentally and physically handicapped to proper treat- 
ment — and the right to refuse treatment by drugs, says Louis M. Thrasher, 
director of the Office of Special Litigation in the Civil Rights Division of the 
Justice Department. 

This spurt of suits arises from an increased use of drugs by institutions with 
staffs which are too small to provide individual care, Mr. Thrasher said, and 
which resort to control by medication even when unneeded. 

On Capitol Hill, Sen. Birch Bayh (D) of Indiana, chairman of the Senate 
subcommittee on juvenile delinquency, says institutions throughout the country 
"may be permitting the indiscriminate use of dangerous drugs for the sole pur- 
pose of controlling the conduct of institutionalized juveniles and easing the 
management problems of understaffed institutions." 

Mr. Bayh's subcommittee, which is studying at least three states which have 
sent troubled children to other states, is working with justice officials to write 
legislation controlling interstate shipment of children. Included in the measure 
would be constraints on other types of shipments such as blackmarketed baby 
adoptions. 

Troubled children are usually shipped out of state when they become "un- 
acceptable" for admission to institutions within the state, say Senate investiga- 
tors. 

"We are concerned about the use of potentially harmful tranquilizers — 
chemical straitjackets as a substitute for humane treatment and quality pro- 
grams," said Senator Bayh. 

In some cases, charge investigators, unwarranted drugging is not simply done 
because of a shortage of staff, but results from "a scandalous kind of public 
policy." 



137 

[Exhibit No. 11] 

[From the Washington Post, Aug. 19, 1975] 

EX-MENTAL PATIENTS TELL OF DRUGGING 

(By Cynthia Gorney) 

A group of former mental patients testified yesterday that indiscriminate 
drugging during their treatment turned them into "zombies" and "psychiatric 

flni$r or i6S " 

In the second of a series of hearings before the Senate Subcommittee to 
Investigate Juvenile Delinquency, six formerly institutionalized people said they 
repeatedly had been given massive doses of incapacitating tranquilizers, often 
after little or no medical diagnosis. 

The subcommittee, headed by Sen. Birch Bayh (D-Ind.), is investigating the 
misuse of drugs in juvenile and adult institutions and will examine improper 
administration of drugs and the availability of narcotics to addicts in jail. 

Janet Gotkin, a former mental patient who now works with a mental patients' 
civil rights organization in Croton-on-Hudson, N.Y., said her 10 years of psy- 
chiatric treatment began after a suicide attempt and rapidly developed into "the 
nightmare of being a psychiatric druggie." 

She said her psychiatrist advised her, without conducting a medical examina- 
tion, to take tranquilizers when she felt anxious. She increased her tolerance 
and cravings for the drugs, she said, taking over the years "almost every drug 
that was available on the market at the time." 

"What's outstanding about what I went through ... is that I'm not immo- 
bilized," Gotkin said, and described at length the debilitating physical side effects 
of the tranquilizers. 

"My tongue was so fuzzy, so thick, I could barely speak," she wrote in a pre- 
pared statement given to the subcommittee. "Always I needed water, and even 
with it my loose tongue often could not shape the words. It was so hard to think, 
the effort was great ... In eight years I did not read an entire book, a news- 
paper, or see a whole movie." 

Psychiatric patients on drugs are trapped in a vicious circle, she said, as their 
self-control diminishes and the physical side effects reinforce their feelings of 
helplessness. "There is no such thing as a voluntary patient," she added. "I went 
down on my hands and knees for higher dosages of the drug. I believed I was 
mentally ill, and I believed I needed the drugs." 

Gotkin said her treatment ended after a five-day coma from which she awoke 
free of drugs and "realized, in a rush, how much of my misery and pain — and 
how much I had been encouraged by my psychiatrist to call my 'illness' — had 
been drug-induced." 

Another witness, writer Anthony Brandt, of Shrub Oak, N.Y., said he had 
feigned mental illness while researching a book on the mental health system. 
Immediately upon being admitted to a mental hospital, Brandt said, and before 
a full diagnosis, he was injected with a tranquilizer. "The basic purpose of the 
drugs is to control the patients, and not to help them," he said. 

Bayh said he has asked the Department of Justice to prepare a report on the 
problems associated with psychiatric drugging. He added that the subcommit- 
tee might consider "legislation directed at such gross abuses of basic civil 
rights and liberties." 



[Exhibit No. 12] 

[From the Detroit News, Aug. 19, 1975] 
INMATES CALLED "TAMED" BY DOPE 

(By Seth Kantor) 

Washington. — Many thousands of Americans in public penal and medical 
institutions are being tamed "very much like the way wild animals are captured 
in the jungle," a New York psychiatrist has told a Senate Judiciary subcommittee. 



138 

"It's as if the custodial guards are shooting tranquilizer guns at the inmates" 
by overdosing them with a new breed of heavy drugs. Dr. Edward Kaufman said 
yesterday at hearings conducted by Sen. Birch Bayh, D-Ind., chairman of a 
congressional investigation into the misuse of powerful mind-managing medica- 
tions known as phenothiazines. 

A trio of nationally recognized medical experts told Bayh that the drugs are 
being widely misused in public institutions across the nation, especially as a 
substitute for brute control over prisoners and patients. 

To use phenothiazines as tranquilizers "would be like using a cannon to shoot 
sparrows," said Dr. Herbert A. Wendel, research specialist in pharmacology at 
the University of Oregon Medical School. 

The drugs can have severe mental and physical side effects, the three experts 

contend. 

One of the most victimized groups of all, said Dr. James Clements, director of 
the Georgia Retardation Center in Atlanta, are tens of thousands of the nation's 
mentally retarded, "warehoused" in state-run centers and immobilized by 
phenothiazines. 

Dr. Clements said students in the nation's medical schools are given meager 
information about what mental retardation is and how to treat it. 

The primary medical school textbook, updated every four years, has 1,589 
pages, said Dr. Clements, and devotes 12 pages to mental retardation. 

Many doctors are not aware of the toxic threat to the heart from longtime use 
of phenothiazines, Dr. Wendel said in his statement. 

Dr. Clements said drug company salesmen, who push hard to get the institu- 
tions to buy large quantities of phenothiazines, are even less familiar with 
diagnosis problems and the dangers of misuse. 

And the drugs are not given scientifically, he said — "often by untrained ward 
attendants who give the drugs and decide when they should be given." 

Frequently used as an expert witness in trials involving the alleged misuse of 
these colorful drugs in centers for the retarded, Dr. Clements said he has found 
licensed nurses are rarely required to administer the system-damaging drugs. 

The most recent federal statistics show 51 percent of the retarded in state- 
run centers are kept on phenothiazines. But Dr. Clements told Bayh he has 
been in state centers which keep from 64 percent to 80 percent of their residents 
on the drugs. 

In one center, he found a child being given "as many as six different tran- 
quilizers at a time," and indicated that the heavy dosages could not be beneficial 
under any circumstance. 

Records "often never show a reason for a resident being put on tranquilizers 
in the first place," said Dr. Clements. 

One of the worst problems, he said, is that the drugs frequently are adminis- 
tered by unlicensed doctors. The situation is so bad in one state institution, he 
said, that foreign doctors are unable to communicate in English. 

They also cannot communicate with the foreign nurses, because the doctors 
and nurses are from different countries and speak different languages, "and 
this is happening right here in America." 

Dr. Clements said the doctors and nurses talk to poorly educated ward 
attendants in sign language. 



[Exhibit No. 13] 

[From the Chicago Sun-Times, Aug. 19, 1975] 
CARELESS USE OF MENTAL DRUG CHARGED 
(By William Hines) 

Washington — A panel of former mental patients Monday asserted — and a 
panel of doctors agreed — that dangerous tranquilizing drugs are being used indis- 
criminately to control and even to discipline patients in institutions throughout 
the country. 

The situation, which one of the doctor-witnesses said is widespread both here 
and abroad, was discussed at a hearing of a Senate Judiciary subcommittee on 
juvenile delinquency. 



139 

Sen. Birch Bayh, (D-Ind. ), chairman of the subcommittee and the only legis- 
lator present, heard a mind-bending series of personal stories by five individuals, 
ages 18 to 38. Then he listened to a psychiatrist, a pediatrician and a pharmacol- 
ogist acknowledge that, however deplorable the reported state of affairs might be, 
it was neither unusual nor surprising. 

At the heart of the matter stood the drug Thorazine, which pharmacologist 
Herbert A. Wendel of the University of Oregon Medical School in Portland said 
is so dangerous that it would never have been approved for use if studies had not 
shown it to be valuable in the treatment of schizophrenia. 

But in practical fact, Thorazine's chief use today in mental institutions is — as 
one former patient put it — "to make zombies" out of inmates. Doses 8 to 10 times 
as great as a prudent physician would ordinarily give a patient are administered 
almost as a matter of course in some institutions, it was revealed. 

Dr. James Clements, director of the Georgia Retardation Center in Atlanta, 
angrily assailed the practice of indiscriminately authorizing untrained personnel 
to administer dangerous drugs. 

Pointing out that medicine's principal institutional accrediting agency, the 
Joint Committee on Accreditation of Hospitals, is on record against the use of 
drugs for disciplinary or control purposes, and that courts have ruled in similar 
vein, Clements said : 

"Why is it that the courts and accrediting bodies have to tell physicians how to 
practice medicine? Because there has been substantial abuse in the prescribing of 
drugs." 

Clements and psychiatrist Edward Kaufman, formerly with the New York 
City prison system, told of widespread use of the notation "PRN" (pro renata : 
Latin for "as the occasion arises") on the charts of patients in mental institu- 
tions, jails and homes for the retarded. 

It is routine in some institutions, Kaufman said, for every inmate's chart to 
have an entry authorizing PRN of Thorazine or some other sedative drug. What 
this does, in effect, is to give any attendant the prerogative of dosing anyone 
whose conduct at the moment does not suit the attendant's fancy. 

Sometimes, patient and physician witnesses agreed, the medication is given 
forcibly. 

The nonprofessional witnesses — two white men ages 38 and 31, two white 
women 32 and 30, a black youth of 20 and an 18-year-old American Indian — 
told of personal or observed instances of indifference and brutality in the insti- 
tutions where they had been confined. The use of Thorazine as a zombie-state 
inducer — and the threat of its use as a deterrent to misbehavior — were described 
as commonplace. 

The patient-witnesses termed the drug dangerous and the medical witnesses 
agreed. Its acknowledged value in helping schizophrenics did not detract from 
its dangers, the doctors said. 

While the testimony in this round of Bayh's continuing hearings on drug abuse 
among the young centered on the misuse of heavy tranquilizers as a "law-and- 
order" tool in institutions, it came out in one witness' story that overuse of 
dangerous drugs is a part of medical practice outside state hospital walls as 
well. 

Janet Gotkin, an apparently recovered veteran of 10 years in and out of insti- 
tutions, angrily told how she was drugged with extra-heavy doses of Thorazine 
by her personal psychiatrist who, she said, regarded manufacturers' recommended 
dosages as "overly conservative." 

She and others in the patient panel are now doing missionary work to reform 
the handling of mental patients. 

[Exhibit No. 14] 

[From the New York News, Aug. 19, 1975] 

INSTITUTIONS CRITICICIZED IN USE OF DRUGS 

(By Judith Randal) 

Washington, Aug. 18 (News Bureau) — A Senate subcommitee was told today 
that the drugs commonly given in institutions for the mentally retarded are pri- 



140 

marily prescribed to correct behavior that the institutions themselves bring 
about. 

Dr. James Clements, the immediate past president of the American Association 
of Mental Deficiency, told the Senate subcommittee on juvenile delinquency that 
these behaviors — rocking, head-banging, masturbation and mutilation of oneself 
and others — can often be traced to the fact that patients have nothing else 
to do. 

"The trouble is that we're using drug therapy and nothing else," Clements 
said. 

CONSIDERABLE BISK 

Thorazine and other phenothiazines, Clements said, were designed for the 
treatment of schizophrenics, but are widely used for all types of mental patients, 
including the retarded, as instruments of control. And if an inmate refuses to take 
the drug by mouth, he added, he will likely be tied down and given an injection, 
which greatly increases the considerable risk of harmful side-effects. 

One of the most dangerous aspects of the situation, according to Clements and 
other witnesses at the hearing, is that doctors leave standing orders that attend- 
ants — with only a perfunctory phone call — may give as much medication as they 
think necessary at any time. 

"In no institution for the mentally retarded that I've ever been in have they 
ever required a licensed nurse to administer drugs," he said. 

LIMITED QUALIFICATIONS 

In many institutions, Clements added, there is either no licensed physician or 
no physician licensed to practice anywhere but there. Communication is especially 
difficult, he said, when — as in one place he knows of — the doctor speaks one 
foreign language, the nurses another, and the ninth-grade attendant only English. 

Clements, who is the director of the Georgia Retardation Center in Atlanta, said 
that it was common in virtually all such institutions for inmates to be so groggy 
from constant drugging that they cannot be taught even to feed, clothe or toilet 
themselves. 

[Exhibit No. 15] 

[From the Baltimore News American, Aug. 19, 1975] 
CHEMICAL STRAITJACKET VICTIMS RAP INSTITUTIONS' DRUG USE 

Washington — (UPI) — Janet Gotkin considers herself a psychiatric guinea pig. 

Wade Hudson, another former mental patient, said tranquilizers are so com- 
monly administered in hospitals that "one injection every week or two and you 
have a nation of zombies, easily controlled." Mrs. Gotkin told a Senate judiciary 
subcommittee Monday she got over 100 electroshock treatments and an estimated 
1 million milligrams of tranquilizers during a 10-year period as a parttime patient 
in three mental hospitals. 

She said that does not make her unique. 

"I am one of thousands," she said, "What makes my story of particular note 
is that I survived, intact, and am here to speak to you today instead of moldering 
lethargic and drugged, a resident of the back wards." 

Mrs. Gotkin, 32, of Croton-on-Hudson, N.Y., was one of six former mental 
patients who appeared before the panel investigating the improper use of drugs 
in adult and juvenile institutions. 

Sen. Birch Bayh, D-Ind., subcommittee chairman, called the procedure "chem- 
ical straitjacketing." 

Mrs. Gotkin said she was first put in a mental hospital in 1961 after she slashed 
her wrist in a psychiatrist's office, and when released 10 months later "started 
the nightmare of being a psychiatric druggie." 

She said she "freaked out" on some drugs, overdosed on others, and felt in 
bondage to one tranquilizer, Thorazine, which she said was administered in 
large doses. 

In 1970, following a five-day coma after another suicide attempt, she said she 
broke out of the syndrome. 



141 

Others appearing before Bayh gave .similar stories of massive infusion of drugs 
during their stays at mental hospitals, often to the point where they lost physical 
control, sometimes unable to speak or read. 

But Dr. Edward Kaufman, medical director of the Lower East Side Service 
Center in New York City, countered that without the drugs "some people . . . 
would not be able to function." 

Hudson, of San Francisco, said that after receiving a dose of a drug upon 
discharge from a mental hospital, his body "felt like it was being twisted up in 
contortions inside by some unseen wringer. - ' 

Mrs. Gotkin said she considers herself a "psychiatric guinea pig." 

"The use of these drugs ... is a political issue," she said. "It's a question of 
power over people's lives." 

Senator Bayh. This subcommittee is in recess, pending the call of 
the Chair. 

[Whereupon, at 1 :55 p.m., the subcommittee recessed, subject to the 
call of the Chair.] 



83-303 O — 77 11 



• 



APPENDIX 



Additional statements and material supplied for the record 



Part 1 — Mental Health and Handicapped Abuses 



In the United States District Court for the District of Columbia 

civil action no. 74, 1800, filed december 10, 1974 

Paul Poe ; Richard Roe ; John Doe ; Through Their Next Friend, Individually 
and on Behalf of All Others Similarly Situated, Saint Elizabeths Hos- 
pital, Martin Luther King, Jr., Avenue, SE., Washington, D.C. 20032; 
plaintiffs 

v. 

Caspar W. Weinberger, Secretary, U.S. Department of Health, Education, 
and Welfare, U.S. Department of Health, Education, and Welfare, 330 
Independence Avenue, SW., Washington, D.C. 20201 — Telephone: (202) 
962-2246 

Bertram S. Brown, Director, National Institute of Mental Health, National 
Institute of Mental Health, 9000 Rockville Pike, Bethesda, Maryland 
20014— Telephone : (301) 656-4000 

Luther D. Robinson, Superintendent, Saint Elizabeths Hospital, A Building, 
Room 105, Saint Elizabeths Hospital, Martin Luther King, Jr., Avenue, 
SE., Washington, D.C. 20032 — Telephone: (202) 562-4000; defendants 

Complaint for Declaratory and Injunctive Relief 
preliminary statement 

1. This class action for declaratory and injunctive relief challenges the in- 
definite commitment of certain persons under the age of 18 to Saint Elizabeths 
Hospital without a meaningful and complete opportunity to be heard, without 
initial and periodic consideration of less drastic placement alternatives, and on a 
different basis than other persons. Plaintiffs are juveniles who oppose their hos- 
pitalization but whose parents or guardians have committed them under the 
provisions of the Hospitalization of the Mentally 111 Act, D.C. Code §§ 21-511 and 
512. 

2. This case arises under the 5th Amendment to the United States Constitu- 
tion. Plaintiffs seek the convening of a three-judge court. Declaratory relief is 
sought pursuant to 28 U.S.C. §§ 2201-2202. 

JURISDICTION 

3. Jurisdiction is conferred on this court by 28 U.S.C. §§ 1331, 1361 and 5 
U.S.C. §§701-706. The amount in controversy under 28 U.S.C. §§ 1331, exclusive 
of interest and costs, exceeds $10,000. 

three-judge court 

4. This case challenges the validity of an Act of Congress, the Hospitalization 
of the Mentally 111 Act, D.C. Code §§ 21-511 and 512. for repugnance to the 
United States Constitution. Injunctive relief is sought pursuant to 28 U.S.C. 
§ 2282, which requires that a three-judge district court, convened under 28 U.S.C. 
§ 2284, hear and determine such cause. 

plaintiffs 

5. Plaintiff Paul Poe is a citizen of the District of Columbia. He was born on 
May 13, 1957 and is 17 years of age. 

6. Plaintiff Richard Roe is a citizen of the District of Columbia. He was born 
on November 11, 1957 and is 17 years of age. 

(145) 



146 

7. Plaintiff John Doe is a citizen of the District of Columbia. He was born on 
February 8, I960 and is 14 years of age. 

8. Plaintiffs Poe. Roe and Doe sue through their next friend Linda Lipton, 
a resident of Washington, D.C. Linda Lipton is with the Children's Defense 
Fund, a non-profit organization concerned with the rights and treatment of 
children. 

9. Plaintiffs Poe, Roe and Doe sue under fictitious names to protect their true 
identities. It is plaintiffs' belief that the use of their names will subject them 
to humiliation, intimidation and embarrassment. Sealed affidavits containing 
plaintiffs' true identities will be filed with the court upon request. 

DEFENDANTS 

10. Defendant Caspar W. Weinberger is sued in bis official capacity as Secretary 
of the United States Department of Health, Education, and Welfare [hereafter 
"HEW"]. He is responsible for the administration of HEW including Saint 
Elizabeths Hospital. This hospital is operated as a federal mental health facility 
serving Washington, D.C. residents and is separate and apart from the District 
of Columbia government. 19,1,3 Reorg. Plan Xo. 1. § 5. IS F.R. 2953. The Secretary 
of HEW appoints the Superintendent for Saint Elizabeths Hospital (24 TJ.S.C. 
§ 165) and allocates HEW funds for the operation of this facility. 24 U.S.C. § 170. 

11. Defendant Bertram S. Brown issued in his official capacity as Director of 
the National Institute of Mental Health, of HEW [hereafter "NIMH"]. He super- 
vises the administration of Saint Elizabeths Hospital and receives reports di- 
rectly from the Superintendent of the hospital. HEW Reorg. Order, August 9. 
1967. 

12. Defendant Dr. Luther D. Robinson is sued in his official capacity as the 
Superintendent of Saint Elizabeths Hospital. As the chief executive officer of 
Saint Elizabeths Hospital, he is responsible for supervision and administration 
of the facilitv. 24 U.S.C. § 165. Applications for admission and release are made 
to Dr. Robinson. D.C. Code §§ 21-511 and 512 ; 42 C.F.R. § 304 ( 1973) . 

CLASS ACTION ALLEGATIONS 

13. Plaintiffs bring this action pursuant to Rule 23(b) (1) and (2) of the Fed- 
eral Rules of Civil Procedure on their own behalf and on behalf of all other 
persons under eighteen years of age [hereafter "juveniles"! who are or will be 
incarcerated in Saint Elizabeths Hospital against their will at the request of 
their parents or guardians pursuant to D.C. Code § 21-511. The members of the 
class are so numerous that joinder of all members is impractical. On information 
and belief, there are at present approximately 40 juveniles in Saint Elizabeths 
who were committed in this fashion : over the course of a year approximately 
120 different juveniles are so committed. 

14. The questions of law and fact presented by plaintiffs are common to all 
members of the class: whether, under the Fifth Amendment, juveniles who 
oppose commitment, but whose parents or guardians request such commitment, 
may be sent to a mental institution without a meaningful and complete oppor- 
tunity to be heard, without initial and periodic consideration of less drastic 
placement alternatives and under a different commitment standard than other 
persons. The claims of plaintiffs are typical of the claims of the class, and plain- 
tiffs will fairly and adequately protect the interests of the class. The relief 
sought against defendants is typical of the relief sought by all members of the 
class. The prosecution of separate actions by individual members of the class 
would create a risk of inconsistent or varying adjudications with respect to indi- 
vidual class members which would establish incompatible standards of conduct 
for defendants. Defendants have acted on grounds generally applicable to the 
class, thereby making appropriate and injunctive and declaratory relief with 
respect to the class as a whole. 

FACTUAL ALLEGATIONS 

15. The Hospitalization of the Mentally 111 Act. D.C. Code §21-501 Ct seq. 
[hereafter "Act"] establishes several types of procedures for placing individuals 
in District of Columbia mental institutions, including Saint Elizabeths Hospital 
[sometimes referred to hereafter as "Hospital"]. The Act permits hospitaliza- 
tion of two groups of people: (1) those who personally desire or do not resist 
in-patient treatment (voluntary and uonprotesting admission, D.C. Code §§21- 
511-514), and (2) those who oppose their incarceration in a mental institution 



147 

(emergency temporary diagnosis and observation, D.C. Code §§21-521-528; 
indefinite involuntary hospitalization. D.C. Code §§21-541-551). The standard 
for commitment and the protections and rights afforded to the allegedly mentally 

ill person during and after the commitment process vary according to the admis- 
sion procedure chosen. 

16. All individuals is years old or over thereafter "adults"] can determine 
the type of procedure and commitment standard governing their admission by 
indicating whether or not they oppose commitment. 

17. If an adult desires to enter a mental institution as a voluntary patient, 
he or she can personally apply for admission (D.C. Code § 21-511), and can 
obtain release within 48 hours by filing a written request. D.C. Code § 21-512. 

18. In order to place an adult in a mental institution against his or her will 
for an indefinite period, involuntary commitment proceedings must be initiated 
by a spouse, parent, legal guardian, physician, public health officer or police 
officer. D.C. Code § 21-541. The allegedly mentally ill person is notified of the 
pending action. Id. This person then receives a hearing before the Commission 
on Mental Health [hereafter '•Commission'*] (D.C. Code § 21-.">42) and can be 
committed only if the Commission finds that he or she is both mentally ill and 
likely to injure himself or others. D.C. Code § 21-544. The Act provides for 
automatic judicial review of the Commission's decision with the opportunity 
to demand a jury trial. D.C. Code § 21-545. Periodic review of the individual's 
mental condition is assured once incarceration takes place. D.C. Code §§ 21- 
546. 548. 

19. In order to place an adult in a mental institution against his or her will 
on a temporary basis for emergency observation and diagnosis, the Hospital 
must comply with strict procedural requirements: Detention of the allegedly 
mentally ill person is limited to 4<S hours unless the Hospital has requested a 
court order authorizing continued hospitalization for a period not to exceed 
7 days (D.C. Code 8 21-523) : the court has 24 hours to rule on the extension 
request (D.C. Code §21-524), and to grant the request must find that the person 
is mentally ill and likely to injure himself or others, D.C. Code § 21-521. If the 
court grants the 7 day request, the person can then obtain a full-dress hearing 
to challenge his continued hospitalization. D.C. Code § 21-525. 

20. Counsel is provided to represent the allegedly mentally ill person at each 
step of the involuntary or emergency commitment process. D.C. Code § 21-543. 
The Public Defender Service is authorized to represent any persons subject 
to such proceedings if they are financially unable to obtain adequate representa- 
tion. D.C. Code § 2-2222 (a) (3). 

21. In contrast, juveniles have no opportunity to indicate whether they want 
or need to be committed to a mental institution. The type of procedure govern- 
ing their admission is determined by the action of their parents or guardians 
without any provision for consideration of the potential conflicting interests 
of the parent or guardian and the juvenile. 

22. Even though juveniles may object to commitment, they can be sent to 
Saint Elizabeths Hospital at the request of their parents or guardians. Such 
requests are made directly to the Superintendent of the Hospital under the 
•'voluntary" admissions procedures of the D.C. Code § 21-511. Despite the fact 
that, such juveniles oppose their commitment and are not free to obtain their 
release until the age of 18 (D.C. Code §21-512). they are nonetheless deemed 
"voluntary"' patients under the law (D.C. Code §21-511), and the safeguards 
provided "involuntary" patients (D.C. Code §§21-541-548) are denied them. 

23. In order to place juveniles in mental institutions against their will when 
their parents or guardians join them in opposing hospitalization, either emer- 
gency or involuntary commitment proceedings must be initiated. Such juveniles 
are then afforded all of the procedural safeguards provided to emergency or 
involuntary adult patients. D.C. Code §§ 21-521-528. 541-54S. 

24. Incarceration in a mental institution has severe consequences for inmates. 
Their liberty is curtailed ; their access to family and friends is limited: they 
are exposed to, and learned to act in accordance with the dysfunctional behavior 
of other patients ; they may be given psychotropic drugs for prolonged periods : 
upon release, thev carry the stigma of having been mentally ill. which severely 
limits their educational and employment opportunities. 

25. Incarceration of juveniles at St. Elizabeths Hospital entails particularly 
severe consequences. Many juveniles are placed on adult wards and spend much 
of their day simp'y watching television, or sitting alone, bored and dejected : 
drugging and tranquilizing occurs on a daily basis. Few meaningful educational 



148 

or vocational opportunities are provided. The Hospital serves primarily a cus- 
todial function. 

26. Prior to the placement of juveniles at the Hospital by their parents or 
guardians, no findings are ni^de that the advantages of in-patient hospitalization 
outweigh the severe curtaPment of their liberty and the stigma caused them by 
incarceration in a mental institution, and that consequently in-patient hospitali- 
zation is the least drastic placement alternative; nor are such findings made 
on a periodic hasis after admission. Juveniles who could otherwise receive treat- 
ment services through less drastic placement, are confined to the Hospital for 
prolonged periods. Less drastic alternatives include hut are not limited to half- 
way houses, out-patient community mental health centers and foster homes. 

27. Plaintiff Paul Poe was sent to Saint Elizabeths Hospital for emergency 
diagnoses and observation on May 3, 1972. 

28. A judicial hearing for review of Poe's continued emergency hospitalization 
was scheduled for May .'50, 1972, hut on that date L'oe's fither. with whom he 
does not get along, fi led an application requesting that Pop Iv m n de a "voluntary" 
patient. As a resu't of this action. Pop was not afforded the procedural safe- 
guards he would otherwise have received as an emergency patient. 

29. Poe did not want to become a "voluntary" patient at the time of his ad- 
mission. Poe has indicated numerous times that he does not want to remain at 
the Hospital, hut his father will not take any action to have him released. Upon 
leaving the Hospital, Poe would like to go to a foster home and learn a trade. 

30. Defendants have admitted and kept Poe at the Hospital without making 
proper findings that in-patient hospitalization is the least drastic placement 
alternative for him. They have neither properly investigated other placement 
alternatives nor provided reasons why such alternatives have been rejected. 

31. Poe has been severely harmed by his incarceration at the Hospital. Poe 
receives daily dosages of phenothiazines, including thorazine and selazine, and 
spends most of his time just sitting on an adult ward. He is receiving no voca- 
tional or educational training, and he is provided only the most minimal recre- 
ational therapy. The custodal service provided Poe in no way counterbalances 
the severe harm caused by his incarceration. 

32. Plaintiff Roe was adjudicated "neglected and dependent" on January 29, 
1973, and made a ward of the D.C. Department of Human Resources Social 
Rehabilitation Administration (hereafter "SRA"). 

33. On February 7, 1973, Roe was sent to Saint Elizabeths Hospital by SRA 
and was held there for emergency diagnosis and observation. 

34. On February 28, 1973, Roe was made a "voluntary" patient on the appli- 
cation of a representative of SRA. As a result of this action, Roe was not afforded 
the procedural safeguards he would otherwise have received as an emergency 
patient. Since becoming a "voluntary" patient, Roe has indicated numerous times 
that he wants to leave the Hospital. 

35. In August 1974, an ex parte hearing was held to review Roe's status as a 
ward of SRA. The District of Columbia Superior Court decided that Roe would 
remain a ward for another year. 

36. Both prior to and following his commitment to the Hospital, Roe was 
diagnosed as mildly retarded. Although the Hospital has no programs for in- 
dividuals with this deficiency, Roe continues to be held in the Hospital against 
his will. 

37. Defendants have admitted and kept Roe at the Hospital without making 
proper findings that in-patient hospitalization is the least drastic placement alter- 
native for him. They have neither properly investigated other placement alter- 
natives nor provided reasons why such alternatives have been rejected. 

38. Roe has been severely harmed by his incarceration ait the Hospital. Roe 
receives daily dosages of phenothiazines, including stelazine, and spends most 
of his time just sitting on an adult ward. He is receiving no vocational or edu- 
cational training and is provided only the most minimal recreational therapy. 
The custodial service provided Roe in no way counterbalances the severe harm 
caused by his incarceration. 

39. Plaintiff Doe was brought to Saint Elizabeths Hospital on August 15, 1974, 
by his mother and was admitted as a "voluntary" patient at his mother's request. 
He consequently did not receive the procedural safeguards afforded involuntary 
patients. 

40. Since becoming a "voluntary" patient. Doe has indicated numerous times 
that he wants to leave the Hospital. Weekend visits have been arranged, but 
his mother does not want Doe to return home at this time. 



149 

41. Defendants have admitted and kept Doe at the Hospital without making 
proper findings that in-patient hospitalization is the least drastic placement 
alternative for him. They have neither properly investigated other placement 
alternatives nor provided reasons why such alternatives have been rejected. 

42. Doe has been severely harmed by his incarceration at the Hospital. Doe re- 
ceives daily dosages of phenothiazines, including mellaril, and spends most of his 
time just sitting on an adult ward. He is receiving no vocational or educational 
training and is provided only the most minimal recreational therapy. The cus- 
todial service provided Doe in no way counterbalances the severe harm caused by 
his incarceration. 

CLAIMS FOR RELIEF 

43. By incarcerating plantiffs and their class, pursuant to D.C. Code §§ 21-511 
and 512, without a meaningful and complete opportunity to be heard, defendants 
have deprived them of liberty without due process of law in violation of the Fifth 
Amendment to the United States Constitution. 

44. By incarcerating plaintiffs and the class they represent, pursuant to D.C. 
Code §§ 21-511 and 512, without initial and periodic consideration of less drastic 
placement alternatives, defendants have denied them liberty without due process 
of law in violation of the Fifth Amendment to the United States Constitution. 

45. By incarcerating plaintiffs and their class, pursuant to D.C. Code §§ 21-511 
and 512, defendants have denied them equal protection of the laws, applicable 
to the federal government through the Due Process Clause of the Fifth Amend- 
ment, in that : 

(a) the statutory commitment scheme discriminates between juveniles who 
object to commitment but whose parents or legal guardians have requested 
such commitment under D.C. Code §21-511 ( "voluntary'' juveniles), and 
juveniles who object to hospitalization but are committed under D.C. Code 
§§21-541 and 21-521 ("involuntary" or "emergency" juveniles), by per- 
mitting incarceration of the allegedly "voluntary" juveniles under a different 
commitment standard and without any of the procedural safeguards pro- 
vided to "involuntary" or "emergency" juveniles ; 

(b) the statutory commitment scheme discriminates between juveniles 
who object to commitment but whose parents or guardians have requested 
such commitment under D.C. Code § 21-511, and adults who object to com- 
mitment, by permitting incarceration of such juveniles under a different 
commitment standard and without any of the procedural safeguards provided 
to adults. 

INJURY 

Plaintiffs and the class they represent have suffered and will continue to suffer 
irreparable injury as a result of defendants' unlawful practices until such prac- 
tices are declared unconstitutional and enjoined by this court. Plaintiffs have no 
adequate administrative remedy. 

PRAYER FOR RELIEF 

Wherefore, plaintiffs, on behalf of themselves and the members of their class, 
pray that this court : 

1. Enter an order convening a three-judge court, pursuant to 28 U.S.C. §§ 2282, 
2284, to determine the controversy. 

2. Enter an order certifying this action as a class action pursuant to Rule 
23(c) (1) of the Federal Rules of Civil Procedure. 

3. Declare that D.C. Code §§21-511 and 512 violate due process of law, and 
the equal protection guarantee implicit in the Fifth Amendment to the United 
States Constitution, in that they provide for the incarceration of juveniles who 
oppose commitment, but whose parents or guardians request such commitment, 
without a meaningful and complete opportunity to be heard, without initial 
and periodic consideration of less drastic placement alternatives and on a differ- 
ent basis than other persons. 

4. Issue an injunction : 

(A) Ordering defendants Caspar W. Weinberger, Bertram S. Brown and 
Luther D. Robinson and their successors in office, agents, assigns and em- 
ployees to immediately inform, in writing and orally, all juveniles who are 
presently institutionalized at Saint Elizabeths Hospital pursuant to D C 
Code §§21-511 and 512 of (1) their right to object to their incarceration 



150 

and be released pursuant to a court approved placement plan, unless a party 
designated in D.C. Code § 21-541 initiates judicial hospitalization proceed- 
ings against them pursuant to D.C. Code §21-541 et seq., (2) their right to 
remain in Saint Elizabeths Hospital as voluntary patients with the power 
to request their release within 48 hours pursuant to D.C. Code § 21-512, and 
(3) their right to discuss their decision to object to incarceration or become 
true voluntary patients with an attorney of their own choosing or a member 
of the Public Defender Service; 

(B) Ordering said defendants to afford plaintiffs, and the members of then- 
class presently incarcerated at the Hospital, a hearing in conformity with 
the procedures in D.C. Code §§ 21-541-545 to determine the need for their 
continued incarceration and whether there are less drastic alternative place- 
ment for them ; 

(C) Ordering said defendants hereafter to inform, in writing and orally, 
all juveniles, prior to any voluntary commitment to Saint Elizabeths Hos- 
pital, of : 

(1) the presently available alternatives to in-patient treatment at the 
Hospital, 

(2) their right to enter the Hospital as a voluntary patient with the 
power to personally request their release within 48 hours pursuant to 
D.C. Code § 21-512, 

(3) their right to object to incarceration and thereupon be treated 
either as emergencv patients or involuntary patients pursuant to the 
procedures set forth in D.C. Code §§21-521-528, 541-548, 

(4) their right not to be committed against their will unless a finding 
is made that said commitment is the least drastic placement alternative, 
and 

(5) their right to discuss their admission decision and treatment needs 
with a private attorney of their own choosing or with a member of the 
Public Defender Service : 

(D) Enjoining said defendants from hereafter committing plaintiffs and 
the members of their class to Saint Elizabeths Hospital against their will, 
without treating them as involuntary or emergency patients, without pro- 
viding them the procedural safeguards set forth in D.C. Code §§ 21-521-528. 
541-548, and without considering less drastic placement alternatives ; 

(E) Ordering said defendants to inform in writing and orally all juveniles 
who. after notice, choose to remain or admit themselves as voluntary pa- 
tients, of their rights as mental hospital patients, on a periodic basis, at 
least every 45 days, such notice to include those rights listed in paragraph 
4(C) (1)(2) & (5) supra; 

(F) Ordering said defendants to : 

(1) Periodically review, at least every 45 days, the necessity of in- 
patient hospitalization at Saint Elizabeths Hospital for each juvenile 
patient and determine whether there are less drastic placement al- 
ternatives for each such juvenile [hereafter "periodic review"] ; 

(2) Provide each such juvenile and his or her parents or guardian 
and lawyer with advance notice that said defendants will conduct a 
periodic review of the juvenile's placement and inform them of their 
right to learn the results of the review process and discuss said results 
with Hospital officials : 

(3) Develop and retain written records documenting the periodic 
review process for each such juvenile ; 

(4) Notify each such juvenile and his or her parents or guardian and 
lawyer, following such periodic review, of all less drastic placement 
alternatives, including foster homes, half-way houses, and <>nt-patient 
community mental health centers, and provide them with the informa- 
tion needed to initiate said juvenile's placement at such alternative 
facilities. 

5. Allow plaintiffs their costs and such other and further relief as the court 
may deem proper, just and equitable. 
Respectfully submitted. 

Stephen P. Rerzon, 

Michael R. Trtster, 

Marian Wright Edet.man, 

i mJ , , . T . , T . , Attorneys for Plaintiffs. 

Assisted by Linda Lipton. 

December 9, 1974. 



151 



2^03 Carey Lane 
Vienna, Va . 22180 

August 19, 1975 



Senator Birch Bayh 
Senate Office Bldg. 
Washington, D. C. 20515 

Dear Senator 3a yh: 

The story in this morning's Post resulting from your committee 
hearings regarding the use of drugs for the "mentally ill" is much 
in line with what I ha V s heard innumerable times in over two yeara 
of anthropological study of the local Schizophrenia Association. 

It appears to me now that there ar° two basic problems as in- 
dicated in the post story (for instancei "... h°r psychiatrist ad- 
vised her, without conducting a medical examination, to take tran- 
quilizers. . .") 

The first problem, and the one most emphasized in literature 
critical of present treatment of the "mentally ill," is the giving 
of drugs (and other so-called "treatment") to people who are not 
actually ill. The second problem, which is just as real, concerns 
people with treatable physicial conditions being given years of 
talking therapy, and/or drugs, in or out of institutions, without 
having ever had thorough physical examinations to try to discover 
underlying biological problems. 

I see general medical practitioners as much at fault as psy- 
chiatrists and other "mental health" professionals and institutions, 
And I wonder how long it has bee n that way. 

^nclosed is a sheet which I wrote rather hurriedly for the 
3AGV to use at a local health fair, outlining some specifics of the 
present contusion as to mental illness and its treatment in the 
D. C. area. 

I hope that the work of your committee will lead into this 

area. Kore is involved in both human and social terms on this 

specific problem than the right not to be on the receiving e n d of 
indiscriminately used tranquilizers. 



Sincerely, 




152 



What is Schizophrenia?* 

Schizophrenia is a disease (or diseases) causing alterations in perception, 
cognition, and affect — that is, it changes sense perceptions (vision, hearing, taste, 
smell, and touch), thought, and feelings. Schizophrenia is a syndrome, a group of 
symptoms, which can be caused by a number of biological or biochemical disorders. 
The "split personality" popularized in books and other media, is seldom seen. 

Schizophrenia is not always the first or last diagnosis given to patients or 
their families. In the Metropolitan Washington, D.C. area, previous or other diag- 
noses have included i 



For Children 
retarded 
borderline retarded with 

emotional problems 
emotional problems 
psyohosis of childhood 
autism 
hyperactivity 



For Adults 
neurotic 
psychotic 

emotionally disturbed 
alcoholic 
nervous breakdown 
anxiety neurosis 
depression 
hypochondriasis 



Some patients in the D.C. area, most of whom previously had been diagnosed 
as schizophrenic, were later re-diagnosed on the basis of man> laboratory tests 
and were found to be suffering from the following conditionsi 



homocysteinuria 

hyperlipoproteinemia 

malabsorption 

hypoglycemia 

trace mineral deficiencies 

cerebral allergies 

pyroluria 



diabetes 
hypothyroidism 
epilepsy 

oongenital syphilis 
syphilis thought to hare been 
cured 



SometiMes there were a number of the above or similar problems which were in- 
terrelated. Sometimes metabolic problems not yet named were found. For some, the 
use of hallucinogenic drugs (marijuana, LSD, amphetamines, etc.) preoipitated or 
maintained the symptomst for soae the symptoms came prior to such drug use. 

"Megavitamin Therapy" (massive doses of certain or several of the water sol- 
uble B-complex vitamins, water soluble C, and sometimes E, but seldom the fat sol- 
uble vitamins A or D) and/or controlled diet has been used successfully for con- 
ditions discovered by laboratory testing in the left column. Other traditional 
medical treatment is used for conditions listed in the column on the right. 

"Orthomolecular psychiatry," the term coined by Linus Pauling for the treat- 
ment concerned with the optimum molecular environment of the mind, appears In 
practice to cover the entire medical model for diseases affecting the mind. 
"Orthoraoleoular psychiatrists" are not the only physicians who can, or should, 
treat the biological or biochemical conditions which can cause symptoms of schizo- 
phrenia. The above and other physiological conditions should be ruled out on the 
basis of laboratory tests before a problem is considered to be "all in the mind." 

•Updated from a paper, "Victims of Schizophrenia," presented at the Annual Meeting 
of the National Council of Community Mental Health Centers, Wash., D.C, Feb. 1975. 



Schizophrenia Association of Greater Washington, Room 407, Wheaton Plaza 
Office Building, North, Wheaton, Maryland 20902; telephone: 949-8282. 



Part 2 — Juvenile Justice Abuses 



Sherman Oaks, Calif., 

November 21, 1915. 
Senator Birch Bayh, 
U.S. Senate, 
Washington, B.C. 

Dear Senator Bayh : I have read with great interest reports of your hearings 
of July-August 1975 concerning overuse of powerful drugs such as Thorazine on 
children, juveniles and adults. 

As you can see from the enclosed Xerox from the Los Angeles Times of 
October 22, we have the same problems here in Southern California as every- 
where else in the country. 

Ethical companies produce drugs with horrendous side-effects which are not 
properly checked out by physicians before they are indiscriminately unleashed 
on the whole population. 

Some 4 million 10-13 year olds are forced to take potent and harmful drugs 
such as Ritalin and Dexedrin in schools because some teacher or even a nurse 
claims that the child is "hyper-active". Thus, by forced feeding of these highly 
addictive drugs, we are creating 'zombies' of our children, while the greedy so- 
called ethical pill manufacturers amass enormous profits by putting totally un- 
proven drugs on the market by unethical methods. 

I would very much appreciate your sending me all of your reports on this 
subject, and wish you all success in this vitally necessary program. 
Very truly yours, 

Alexander Satin. 

Enclosure. 

[From the Los Angeles Times, Oct. 22, 1975] 

PROBE ORDERED INTO DRUGS FOR JUVENILES 

COUNTY DISPENSING MEDICATION WITHOUT DIAGNOSIS OF PRESCRIPTION, DOCTOR SAYS 

(By Ray Zeman) 

Charges that the Los Angeles County Probation Department administers 
powerful tranquilizers to children without a physician's diagnosis or prescrip- 
tion were ordered investigated Tuesday by the Board of Supervisors. 

The charges came from the department's former medical director. Dr. Thomas 
F. Trott, who said he had severed his association with the department because 
of "frightening recent developments involving the use of psychoactive medica- 
tion," such as the tranquilizer Thorazine. 

Trott also expressed concern that cutbacks in medical personnel are allowing 
serious medical disorders, such as epilepsey, to go untreated in youngsters held 
in Probation Department custody. 

The supervisors ordered the county chief administrative officer's special in- 
vestigation division to make an extensive probe of Trott's accusations. 

Trott said that, under standing orders of the department, the powerful drug 
Thorazine is given by muscular injection "to those deemed as seriously agitated 
by nursing personnel without it being necessary for a physician let alone a fully 
trained psychiatrist, ever to see the child."' 

Trott warned that the Probation Department's disregard for children's physi- 
cal and mental health would lead to tragic consequences. 

Since Jan. 1, he said, tuberculosis skin testing has been eliminated despite an 
increase in the TB rate within the county. 

a 53) 



154 

"Of equal public health concern," he wrote to Chief Probation Officer Clarence 
B. Cabell, "is the elimination of routine immunizations for childhood diseases 
such as tetanus, diphtheria and whooping cough, even though many of the chil- 
dren are unprotected. 

"Although hypertension is a major health problem, especially for black males, 
the Probation Department does not even take routine blood pressure on detention 
at Juvenile Hall." 

Cabell was out of the city at a conference and his office declined to issue any 
statement. 

Trott resigned Jan. 14 as medical director for the department but since has 
served as its consultant in psychiatry. 

"On Jan. 1, 1975, there were two full-time psychiatrists in the Probation De- 
partment," Trott wrote. "Now there are none. 

"Although the Board of Supervisors funded seven psychiatric social worker 
positions, only two have been filled." 

In mental health services, psychiatric consultation formerly was provided at 
all probation camps except one. 

Now, Trott said, this service has shrunk to only two of the 10 camps and 
coverage at these has been reduced by one-third. 

The Probation Department currently has supervision over 2,307 juveniles. 

Of these, 1.34S held in juvenile halls are law violators, incorrigibles, truants, 
youngsters having problems with their families or others awaiting court action. 
Eighty-nine at MacLaren Hall are neglected children. Another S79 are wards of 
the court assigned to camps and schools. 

"Although the Board of Supervisors has passed several motions requesting 
removal of mentally ill children from detention facilities," Trott said, "the Pro- 
bation Department policy has been to eliminate those mental health professionals 
who would be able to diagnose these children." 

Physical health care also has deteriorated, Trott charged. 

In the past, each child was examined by a physician upon detention at Juvenile 
Hall and upon transfer to a probation camp. Now, he pointed out, this is done 
only once a year and a youth often is transferred to a camp without seeing any 
trained health professional. 

"Only a review of the medical records is undertaken," Trott said. "As these 
records are often incomplete or missing, the effect is to send children into remote 
areas with unknown disorders such as epilepsy without medication or any other 
form of treatment." 

Supervisor Ed Edelman said the Thorazine procedures should be questioned 
as to legal and medical appropriateness. 

Other points raised by Trott also are "of sufficient gravity to warrant an in- 
vestigation," Edelman said. 

County supervisors unanimously adopted his motion for a study of the psycho- 
active, depressant and serlative medications and changes made in the last 10 
months in the Probation Department's mental and other health services to indi- 
viduals in custody. 

The special investigations division was directed to report its findings within 
30 days. 



155 




COUNTY OF LOS ANGELES • DEPARTMENT OF HEALTH SERVICES 

313 NORTH FIGUEROA STREET • LOS ANGELES. CALIFORNIA 90012 • PHONE 97^-7701 



LISTON A. WITHER ILL 

oirector 

phone 2i3-97>i-8]Oi 

MORRISON E. CHAM3ERLIN 
Cmiet deputy director 

*ho«e 2i3-97*t-8io»i 

JOHN E. AFFELDT, M.D. 

MEDICAL DIRECTOR 
PMONE 213"97l)-8l06 



HEALTH SERVICES 

PREVENTIVE HEALTH 
HOSPITALS 
MEKTAL HEALTH 
COMPARATIVE VETERINARY 
MEDIC INC 



CENTRAL 



OEPUTT 

1100 N. 

LOS ANCCLCS 



RECTOR 
ISSION ROAD 
90033 
PHONE 213-226-61*21 



COASTAL 

DONALD W. AVANT 
DEPUTY DIRECTOR 
1 1*01 CHESTNUT AVENUE 
LONG BEACH 906l3 

phone 2i3-775-7 1 *oi 

SAN FERNANOO- 
ANTELOPE VALLET 



7533 V * N wu^s eOULC 1 

ROOH 1*00, SOUTH TOVI 
VAN NUTS 91U05 
PHONE 2I3-997-I8OO 



SAN GABRIEL VALLEY 

ALV1N KARP 
DEPUTY DIRECTOR 
l'*35 WEST COVINA PAI 
WEST COVINA 91790 
PHONE 213-338-81*61 



SOUTHEAST 

MELVIN J. FLEMING 
DEPUTY DIRECTOR 
12020 COHPTON AVENUE 
LOS ANGELES 90059 
PHONE 2I3-636-O96I 



April 8, 1976 



Honorable Board of Supervisors 
383 Hall of Administration 
Los Angeles, California 90012 

Gentlemen: 

RECOMMENDATIONS FOR IMPROVING THE 

QUALITY AND APPROPRIATENESS OF PHYSICAL 

AND MENTAL CARS OF DETAINEES 

On December 23, 1975. your Board instructed the Director of the 
Department of Health Services to establish a Task Force to examine 
the health care policies and procedures of the Probation Department, 
relating both to physical and mental care of detainees, in order to 
determine the quality and the appropriateness of those services. 
In doing so, you charged the Task Force with an evaluation of the 
existing Probation health delivery system and with the development 
of a plan for implementation of recommendations developed as a 
result of the evaluation. It is my privilege as Chairman to 
transmit to you the Task Force's report on this subject. 

This report is intended to make recommendations on the organization 
required for a comprehensive health care system for detainees of 
the Probation Department, rather than to be considered as a 
guideline for operational policy decisions. 

I would personally thank the members of the Task Force and the staff 
of the Probation Department, the Department of Health Services and 
the County Chief Administrator's Office for their valuable 
contributions during the evaluation. 

In its evaluation, the Task Force carefully considered the findings 
and the recommendations of the following documents: 

-The Health Standards for Juvenile Court Residential 
Facilities as prepared by the Committee on Youth of 
the American Academy of Pediatrics. 

-The Statement of Iris J. Litt, M.D. , Medical Director, 
Juvenile Center Service, Division of Adolescent Medicine, 
Montefiore Hospital and Medical Center, before the United 
States Senate Committee on the Judiciary, Subcommittee to 
Investigate Juvenile Deliquency on September 17, 1973. 



156 



Honorable Board of Supervisors 
April 8, 1976 
Page Two 

■ 
-The Standards for Juvenile Halls of the Health and Welfare 
Agency of the State of California. 

-The report prepared for the Probation Department by the 
Department of Health Services on the Medical Division of 
Juvenile Hall — March 17, 1975- 

-The report prepared by the County Chief Administrator's 
Office on Health Care Provided Juveniles in Probation 
Department Facilities — November 1975. 

-The report prepared by the County Chief Administrator's 
Office on Probation Detention Facilities' Medical Intake 
Procedures — December 1975. 

These reports and statements logically precede this Task Force report and 
it is the request of the Task Force that your Board give careful attention 
to them. 

Based on the results of this study, the Task Force on Health Care Policies and 
Procedures of the Probation Department recommends that your Board: 

1. Approve the recommendations presented and discussed in the 
report. 

2. Instruct the Chief Probation Officer, the Director of the 
Department of Health Services and the County Chief 
Administrator to develop, with participation of the 
affiliated School of Medicine, a plan for implementation 
of the recommendations of the Task Force, this plan to be 
submitted within 90 days. 

3. Terminate the Task Force on Health Care Policies and 
Procedures of the Probation Department as presently 
constituted, it having completed its work, with the 
understanding that individual Task Force members are 
most willing to assist in implementation of the 
recomraendat ions . 



Very truly yours, 

APPROVED BY: 

Martin D. Finn, M.D., M.P.H. 

Deputy Medical Director— ~L. J X" Vitherill 

Preventive Health Services Director of Health Services 

MDF:ft 

cc: Executive Officer, Board of Supervisors (30) 




3S^ 



157 




\_, jti i ej l- AL;:viiiMa ii\aii vn r_> i- 1 £* J. ^ Hi irt 
COUNTY OF LOS ANGELES 

TI3 MALL Of ADMINISTRATION / LOS ANGELES CALIFORNIA 90012 074 — 1101 



November 26,' 1D75 



MAPflV L WUFFCHD 

CHIEF ACMiNiSTflAlivE OfFiCEfl 



HONORABLE BOAPJ) OF SUPERVISORS 

County of Los Angeles 

383 Hall of Administration 



uemser: :r i-z ec*»3 

JAMES A MAYES 
CHAIRMAN 

PETER. F SCHA9ARLM 

KENNETH HAr-N" 

EDMUND EDELMAN 

; BAXTER rtArO 



Gentlemen: 



HEALTH CARE PROVIDED JUVENILES IN 
PROBATION' DEPARTMENT FACILITIES 



This is our report on the results of the investigation of charges 
by Dr. Thomas F. Trott, former Probation Department Medical 
Director, concerning; health care provided juveniles in the custody 
of the Probation Department. 

The investigation was made by the Special Investigation Division 
of the Chief Administrative Office as directed by the Board of 
Supervisors on motion by Supervisor Edclraan on October 21, 1975. 



The Board directed that the investigation include 
limited to: 



but not be 



1. The procedures followed in the Probation Department in the 
administration of psychoactive, depressant and sedative 
medications to individuals in the custody of the department. 

2. The extent to which individuals in the custody of the department 
• are administered psychoactive, depressant and sedative medica- 
tions and for what purposes these medications are utilized by 
the department. 

3.. Changes made over the last ten montbs in the jirovision of 
mental health services to individuals within the custody of 
the department. 

4. Changes made over the last ten months in the provision of 
other health services to individuals in the custody of the 
department . 

In our investigation we discussed the background and bases for his 
charges with Dr. Trott. We reviewed the current pulicics end pro- 
cedures for the provision of health care services to juveniles in 
custody of the Probation Department at its 1G juvenile detention 
and treatment facilities located throughout the County. We inspected 



ATTACHMENT -A 



33-303 O - 77 - 12 



158 



the departmental pharmacy and the medical supply storage area at 
each facility to determine the adequacy of physical security and 
procedural controls on arug use an< -l operational compliance to other 
departmental health care standards. 

To provide an independent , professional assessment of health care 
practices, we also requested the Chairman of the Ad Hoc Committee 
on Health Care for Detained Youth, American Academy of Pediatrics 
to inspect the main departmental medical clinic at Central Juvenile 
Hall. The American Academy of Pediatrics noted several medical 
practices they deem not corresponding to current community medical 
standards and has recommended changes in these practices and other 
measures to improve health care. 

Our principal findings, detailed in the .attached report, are 
summarized in the following: 

— Different psychoactive, depressant, and sedative medications 
are prescribed by departmental physicians and psychiatrists. 
On a one-day sample on October 27, 1975, such medications 
(10 varieties) were administered to 89 detainees out of a 
total population of 1,397 in detention facilities not in- 
cluding placement camps. 

— Since January 1973, Probation Department nurses have been 
authorized to administer Thorazine, a psychoactive medi- 
cation, in emergency situations when a physician cannot 

be contacted. V.'e found evidence of only one such incident 
and the issuance of Thorazine by the central departmental 
pharmacy has declined in 1975. 

— The issuance of drugs by the central departmental pharmacy 
is rigidly controlled and the physical security of drug 
inventories at detention and treatment facilities is 
adequate. According to a representative o." the State Board 
of Pharmacy, however, maintenance of stocks of prescription 
drugs at facilities other than the Central Pharmacy may be 
in violation of State Peguiations. 

— Ongoing psychiatric services to all but two camps were 
discontinued because of the current year budget curtailment 
which also provided the deletion of five clinic positions 
that liad never been filled. Psychiatric services to other 
facilities and court ordered evaluations continue unchanged. 
On October 21, 1975, the Probation Department requested 
Short-Doyle funding to rcinstitute psychiatric services 

to all other camps during fiscal year 197G-77. 



159 



— Changes in other health care practices since January 1975 
include the elimination of routine immunizations and 
tuberculosis testing and provision of these services on 

a selective basis; addition of routine blood pressure tests; 
reinstitution of physical examinations prior to cainp 
placement; and implementation of procedures to ensure a 
detainee's medical record accompanies him. There are dif- 
fering medical viewpoints regarding several Probation 
Department health care practices. 

— The Probation Department's medical function has been 
reorganized and is now under the administrative direction 
of a non-medical professional administrator. 

In summary, we found sufficient medical differences of opinion 
regarding Probation Department health care practices and other 
areas relating to health care such as training, written procedures, 
infirmary quarters, and personnel utilization, to conclude that 
health care provided detained juveniles can be improved. 

We recognize that there are many problems in providing adequate 
health care to confined juveniles and that to maintain the highest 
standards of such health care is not an easy task. There arc con- 
flicting nriorities placed on the juvenile detainee — his need for 
health care, treatment, and other custodinJ demands; the require- 
ment that he be in court at prescribed times; and other factors 
such as the available bed space in departmental facilities and 
placement resources. 

Although these problems are not insurmountable, considerable effort' 
vill be required of the Probation Department to arrive at solutions 
and to coordinate the health care activities. We believe, however, 
that the benefit to be attained — better health core of detained 
juveniles — far outweigh any of the difficulties thnt can be foreseen. 

THgnEPors. v-i; tj:co::-:;^:d that the doapj) 

OF SliPiiUViSuho: 



1.. Instruct the Acting Chief Probation Officer to establish a 

Task Force, including medical representatives of the Probation 
Department, Department of health Services, and American Academy 
of Pediatrics, with the objective of exploring methods for 
improving the quality and appropriateness of health care services 
in the Probation Department and to present to the Board of 
Supervisors a plan to implement the recommendations of the 
Task Force, if any, within 60 days. 



160 



2. Instruct the Acting Chief Probation Officer to review with 
County Counsel and representatives of the State Board of 
Pharmacy the current procedures for rraintaining and dispensing 
of prescription drugs at Probation Department facilities and 
. to implement any changes that may be necessary to conform 
with legal requirements. 

Sincerely yours, 
ftf... <* 



•IIARPvY L- HUFFORD 
Chief AU.:!i^.iSt,rative Officer 



IELH:SIC: 

JAW:lIPK:mo 

Attacluncnt 

cc: Each Supervisor 
County Counsel 
. Acting Chief Probation Officer 
Director, Department of health Services 



161 



Prisons, Adolescents., and 
the Right to Quality 
, [Viedicai Care 

The Time Is Now 



IRIS F. LITT. MO 
MICHAEL I. COHEN. MD 



A comprehensive medical program was established within 
a teenage detention facility. Although a large part of the 
detained population suffered from preexisting poor health, 

frequently worsened by an antisocial life-style, much 

could be accomplished in the prevention and treatment 

of disease within the prison setting. 



Introduction 

Kcrenl events ill llic Allica. Hikers Island, and San 
Qucnlin penitentiaries have focused attention on the 
frustration., ind inadequacies of this country's prisons. 
Among the problems highlighted has been the delivery of 
health ere in penal institutions. Medical i are in such 
settings is typically provided by en individual physician, 
assisted by a few nurses, and is crisis-oriented. Little health 
rehabilitation is undertaken and programs of preventive 
medicine or of health education are rare. A reeentedilnrial 
in the medical literature ended with lite plea that physii ..ins 
would "cast ... an occasional thought for the needs of the 
sick and for the way of life of the healthy who are 
involuntary quests of our society." 

The experience of the Division of Adolescent Medicine 
of Montefiore Hospital and Medical Center uver the nasi lid 
months with adolescent prisoners suggests that the medieaj 
needs of those in detention, whether adulU or adolescents, 



Dr. Lilt is an Assistant Professor of Pediatrics and Dr. 
Cohen is an Associate Professor of Pediatrics in the Division 
of Adolescent Medicine, Department of Pediatrics, MoMc- 
fiore Hospital anil Medical Center, and Hie Albert Einstein 
College of .Medicine, llronx. New Vork luH>7. 



may be well served by a team of health professionals with 
the backing of a medical center, 'n addition, much is to be 
gained in the area of staff education l>> the nieriical center 
providing support for such a program. To encourage other 
medical centers to become involved in this heretofore 
largely neglected .uea of health eare, we report llns 
experience. 



Background 

The Juvenile Centers of the City of New Yurk were 
established for the temporary detention of children 
between the ages of H and 1H sears from the five boruug!i> 
of the City who .ire adjudged either "ilehiiipient" or 
"persons in need of supervision." They an' placed in 
detention by the Family or Juvenile Courts lor an average 
stay of 2 weeks while disposition plans are completed by 
probation officers. The centers at present arc operated by 
an executive branch of the municipal government. Hie New 
York City Human Itesources Administration. 

There are approximately li.'JUU admissions each ycjr. 
Uoys outnumber girls in a ratio of 2:1. Ilelween 1:01) and 
400 teenagers are ill residence at one time, housed wilmn 
two facilities located about 7 miles south of Montcfiorr 



894 AJPH SEPTEMBER, 1074, Vol. G4. No 



162 



. Hospital in a high population density, high crime area of 
the liruiix winch is relatively inaccessible by public 
transportation. The mandate uf temporary. >rl secure, 
detention, a high turnover rale, and a siniJI custodial- 
counseling staff lias precluded meaningful rvhabihuuon 
procrumi within the centers to date, although all ctnlda-n 
Hleitd school and participate in recreational urograms. 

After leaving the centers, a maionty of the children 
return home on probation. Twenty percental? transferred 
to State Training bchools (juvenile prisons) and Lnc 
remainder may be placed m smaller municipal or state penal 
prugnuns, which are urban, suburban, or rural in locale. 
Local drug rehabilitation programs also receive a number of 
these youths. 

Prior to the Montefiure Hospital affiliation program, 
medical care was provided by a physician who visited the 
centers for 1 hr each weekday, agisted by nurses. There- 
was no program of upgrading or in-service education of the 
nursing slafl\ no routine diagnostic screening program lor 
the inmates, and medical evaluauon apparently consisted of 
a cursory physical examination. Only "court-ordered" 
laboratory' procedures, such as the VDKL, vaginal smears 
for the gonococcus, and pregnancy tests for girls who were 
home runawuys, or electroencephalograms on those who 
"acted out," were consistently performed. Those in need of 
emergency care ur hospitalization were cared lor in the 
Dusy emergency room ol a nearby municipal hospital. The 
infirmary was a small, dark area with peeling paint, poor 
ventilation, broken Venetian blinds, dirt-encrusted wmduw 
screens, and illumination which was deemed secure, but 
offered little light. There wis no system of communication 
between patient rooms jna the. nurses' area. Furthermore, 
it night the children were locked in their rooms, which 
.■untamed neither sinks nor toilets. The program now op- 
erates out of a modern, cheerful area designed to meet 
patients' and physicians' needs. A complete dental unit, 
pharmacy, laboratory, modern equipment for diagnosis and 
treatment, and a recreation room now exist, in aadiiion to 
j.1 IB-bed infirmary and appropriate examination and treat- 
ment rooms. 



Methods and Materials 

The Mcntefiorc Hospital program, under an affiliation 
contract, commenced uii July 1, labH, and consisted of 
three components: quality patient care, professional and 
patient education, and health data collection. The service 
program consisted of a system of delivering care to those 
more seriously ill teenagers in need of hospitalization 
•within the infirmary at the S. Center or un the Adolescent 
In-i'alienl unit at Montefiure Hospital. An ambulatory 
program was designed which segregated the general medical 
screening of new admissions and ongoing care for those 
already in residence. The latter was divided into "sick-call" 
and "medication call" programs and several specially 
programs. 

Intake screening was performed at the time of 
jdmissiun to the facility by nurses who evaluated the need 



for immediate attention by a physician and, if none existed, 
(hey obtained and recorded vital signs, height, jnd weight, 
and implanted a tuberculosis sireeiung lest. The iulluwuig 
day, or immediately if indicated, the patient Wussei-u by a 
house officer who obtained a medical history and per- 
formed a complete physical examination. The following 
dugnostic tests were regularly performed on all inmates in a 
laboratory set up on the premises and staffed by two 
technicians: urinalysis, hematocrit, sickle cell anemia 
screening test, and VDKL. A pregnancy lest and vaginal 
culture for gonorrhea were obUiued on all sexually active 
females, while liver fuuctiun studies were roulinely ob- 
tained on all drug users. Immunization inoculations were 
brought up to dale. The palient was screened by a denial 
hygienisl who ottered instruction on the Lare of teeth and 
referred those in need of i'urllier dental care to a denial 
inLem and oral surgeon wilhin the center's health area. 

Services U> lkjy. " inn:.!/- in residence consisted of a 
twice ..aaily '*.. - I'.l I — ■- centralized medical jri-d and 
infirmary at ts. Center siuffeti by nurses and house officers 
also supplied a 21-hr telephone consultative service to the 
uthcr center. The infirmary was available at all times lor 
emergency ere with trans-shipment ol patients lo Monte- 
fiorv Hospital if the situation warranted. 

Medications were dispensed by nurses and pharmacists 
utilizing a unit dose system al'U-r preparation by the 
pharmacy staff from Montefiure located in the prisun. 
Weekly clinics were established al Ihe center for surgical, 
prenatal, and gynecological problems. Daily dental clinics at 
the center to effect emergency, as well as restorative, care- 
are now in session. 

The infirmary was used for inmates with communi- 
cable diseases, drug withdrawal, severe infections, trauma, 
gynecological disurdcrs, and a variety ol medical problems 
of a moie serious nature. Those patients in need ul* surgical 
or intensive medical care were translerred to the lu-1'atlVill 
Adolescent Unit al Montefiure Hospital. 

An average of 'J.UOU r.ul.ciils leave the center each year 
who require aftercare fur unresolved medical problems. 
Previously, Ihe only mechanism available lor dealing vsiLh 
this problem was submission of letters lo Ihe patient's 
parents or guardian with no method for determining 
whether adequate fullow-up care was being received. Fur 
this reason, a follow-up prugram utilizing family health 

TABLE 1-Hejllh Problem* Idunlitiod in 31.323 Adolescsnli 
through MtUical Labjr-ilory ScruomiMJ ProcuOuru, uiitin 
Admission to J Youlh Dolunlion 'jciIii^ 



Hejlih Problem 



No. 



Hepatitis, subclinical 
Venereal discte 
Tubeicohn posntve 
Prc-yn.ji.cy 
Sickle cell trail 
Urinary tiaci infocnon 



2.B10- 
824 
!)91 
605 
804 
4B0 



"Refers to abnormal serum chemical dnalysev perlr.rmcd on 
9,436 c?rug uters j.sd noi nocessarily ace Id vual hcpdlini. 



PRISONS, ADOLtiXENTS. ANO MEDICAL CAME 0'J5 



163 



workers was designed and became operational in 1972. The 
program guarantees Dial any leenatfer found to have 
medic. il problems while at the comer will be enrolled in an 
appropriate health facility near his or her residence and that 
other members of the lamny with the same condition will 
be identified and similarly treated. 

Training is considered to be a vital function of this 
prison health program. Twenty nurses, three pharmacists, 
and two laboratory technicians are involved in ongoing 
in-service training through conferences, visiting attending 
physician rounds, ana periodic rotations back to Mcnte- 
fiore Hospital where they received their initial training. A 
resident, intern, and medical student from the Albert 
Einstein College of Medicine participate in the urogram, 
including a night call rotation for a A- to H-weck period. 
.Staff physicians at the prison have full-time academic 
appointments at the Albert Uiiisti'in College of Medicine 
and participate in all aspects of the Division of Adolescent 
Medicine at Monfefiore Hospital. 



Results 

In the (if) months since the program was instituted, 
31,32.') patients have been evaluated. Forty-six pei cent of 
these presumably healthy teenagers were found to have 
medical problems. A list of the most common of these, 
found on the basis of laboratory screening alnne, is found 
in Table 1.. 

One-third of the teenagers entering (he center have 
been identified as drug ahusers on the basis of medical 
history and physical examination." 

Of the drug users, 2. Ml j. or .1') per cent, were found Io 
have elevations of serum glutamic pyruvic transaminase 
values at the tune of admission to the center Liver biopsy 
was performed on Hfi of those whose chemical abnormal- 
ities persisted far at least ;i months '.villi the finding of 
chronic persistent hepatitis in most.' The diagnosis of 
venereal d.,ea.c was based either on the finding of a 
positive VlJKI., confirmed by a positive fluorescent 
treponemal antibody-absorption lest, or a positive culture 
for gonorrhta on Lester Martin media. Only one patient 
was found lo have aclive pulmonary tuberculosis, bul .VM 
adolescents received r-onu/id therapy because ol a positive 
tuberculin skin lest of indeterminate duration. Of H.U77 
patients leslcd, Mf) I were found to have sit kle trail, 
although no patients w-.tli homozygous sickle eel! disease 
were delected. Counseling of those with the trail was 
conducted by lilt' Nursing .Supervisor. 

The diagnosis of pregnancy was made upon admission 
in 4.5 per cent of the girls with an average age of 1-1.5 
years. None of these patients had used contraception Only 
19 per cenl chose to have an ahurlion, despite easy 
availability of elective termination of pregnancy in New 
York State since 1<)70. 

Asymptomatic urinary trad infection was diagnosed m 
480 (M81 females and 99 ma'esl on the basis of a urine 
culture showing greater than 100,000 bacterial colonies 
performed after the screening urinalysis revealed pyuria. 



There have been 1,93b patients admillcd In the 
infirmary; in addition, 3tj'J patients required transfer to the 
Adolescent lll-1'atient Unit at Monu-liorc Hospital. An 
analysis of aamiMiun uia b nos.-s for these gToupi. ;s found in 
Table 2. 



Discussion 

Rotation through the medical service of a detention 
facility exposes health professionals from all disciplines in a 
group of patients who have had little prior medical die al J 
time when their social and emotional problem, an- uT 
greater concern lo them than physical ills. As many uf the 
medical problems are inexlncably related to the patient's 
social environment, the role of the health professional ,;ues 



TABtE 2-Oiaynoitic Categories ol Health Problems Identifies! in 
2,304 Teenagers Either Admitted lo the Proan In 
firmjry or Referred lo Ihe In Patient Adolescent Una 
during » GO Month Period 



Category 



1. Infections 

Respiratory 

Cardiovascular 

Oerm.ilological 

Central nervous system 

Venereal 

Gastrointestinal 

Hepatic 

Genitourinary 

Dental 

Other 
2. Metabolic problems 

Diabetes 

Hematuria 

Proteinuria 

Hypertension 

Other 
3s Trauma 

Skull 

E*lremiues 

Other 

4. fsleuplasfns 
Malignant 
Ncnma'rgnam 

5. To«ic reactions 
Overdose syndromes 
Abstinence syndromes 

6. Congenital m.illormanons 
Genitourinary 

Cardiac 
Other 

7. Allergy problem* 
Asthma 

8. Psychiatric disorders 

9. Miscellaneous piab'ems 



No. 



294 

27 

171 

7 

279 

90 
249 

32 
. 12 

4G 

40 
78 
23 
' 9 
34 

6t 
93 
39 

5 

30 

Gl 
2B2' 

89 

9 

23 

30 

61 

2U0 



' An additional 944 paimnts were Ueio«ilied on an ambulator* 



S90 AJPH SKPUMUCn. 1974. Vol 04. No. 9 



164 



lvyund that within tin." irndilional hospital selling. II Is nut 
lulficicnl, foe example, in diagnose and trval pcpiic ulrvr 
disease in Hi" teenage girl .it lilt- cviiler. Our must ask where 
tin' patient .v.li go fur rollmv-»i|i medical can - and liuw tin- 
court's disposition infill affect the disease process or its 
U)era*>v, In addition, consideration must be given to 
•hcllicr incarceration in a p«.ii j| institution may affect 
eruption in pathophysiology as in diabetes, asthma, peptic 
uleer, and epilepsy, as well as cum plicate the differential 
diagnosis of amenorrhea, for example. The medic. d sludcnu 
and house officer, routine; through the center rapidly 
become proficient in identifying physical signs of drug 
abuse, in taking a drug abuse history, ill treating narcotic 
and barbiturate abstinence syndromes, and in detecting and 
treating the somatic consequences and complications of 
drug abuse. I-ess tangible effects of this exposure accrue 
from tile inevitable process of introspection that accom- 
panies a short, hut intense, relationship with the young 
drug user; from the frustration ot seeing a patient 
detoxified and returned to his original environment, only to 
Mum again to prison once more addicted; from the 
conflict of Ihe confidentiality of the doctor-patient 
relationship as one relates to the courts and the importance 
of knowing that the disposition resides ultimately Willi the 
judiciary, not with the doctor, as in a traditional hospital 
selling. 

Although our experience has been Willi leenage 
"prisoners," Ihe system of delivering medical care described 
herein could be equally applicable 10 a detained population 
of adults. Adull pn-.oners, lor the most part, also come 
from inner city areas and wouid therefore be expected to 
suffer from many of the same medical problems as the 
udolcscenls described here. Reports of medical complica- 
tes in adull heroin addicts, who nughl constitute a 
significant proportion of tiie prison population, suggest that 
Uipy have additional problems, such as tuberculosis, ulcer 
discjse, and tetanus. 

Ill a long term secure detention facility a full-time staff 
of health professionals— physicians, nurses, laboratory Iccli- 
r.icians, pharmacists, dentists, dental hygiemsts, and social 
workers— may also serve die inmates in a training capacity, 
teaching selected, responsible inmates to function as 
paramedical personnel and health aides. This would not 
only provide additional skilled manpower for the imprison 
medical service, but would also serve as an excellent 
rehabilitation program for some prisoners. It would offer 
meaningful work activities during tile period of their 
detention, as well as I raining and experience tiiat would 
assist llicm in obtaining employment after release. 



The presence of a discipline uiher lli.ui currvctioii ur 
law cnlnn cinciil wiUiiii Ihe closed ilclculioit facility has 
the advantage of introducing iuiinv.iti.uis lu the uihniuislr.t- 
lion, for example, the refusal lu lurk adolescents in their 
rooms in the inliriiinr) ,uej was initially grc-p-n with 
cuueern, if nut alarm, on the part uf the |x-rsoiiuel. 
StJUsequt'i*! experience that no stall" member was injured by 
those whose rooms were not secured prompted Hit- 
adoption of an "open door" policy ill Ihe rest of the 
facility. Tlii' adi.iis.siou of more- tii.m liliO teenagers from 
the center to the nonsecuie environment of the Adolescent 
Unit al MouUTiure UospiL.il Willi an "elopement" rale of b 
per cut also reinforced in some probation and correctional 
personnel the concept thai many Iccu.igcr, did not need 
secure detention. I'nrll.tll) as a result ol these observations, 
a program of foster liouic and small group hoim- plji ciuculs 
for many o( these adolesccuLs is now uperalional and 
expanding lu New York City. 

lu summary, Ihe experience of the Division of 
Adolescent Medicine's affiliation Willi a yuulh deleutluii 
facility lias shown that the delaineil pupulaliim suiters 
from preexisting poor iie.il r li liv virtue ol la. k of medical 
care prior to detention and that eerlain medical conditions 
are by-products ol Hie lile-slyle of lluise who eventually 
become imprisoned. .Much .an be done lilcdlcalh, lor 
detainees, even during a sliurl perunl of leiu.inil, and 
opportunities for epidemiological suivclllahi e of ijine-.s ;ire 
gre.il. Isusy access to qll.illly inedit.il care also u-duces 
tension and Irustration within a prison M-LLiii^;. It is 
suggesLed thai certain carefully selected prisoners detained 
for a long period ol' lime may be excellent candidates for 
training as allied health workers by the medical staff. 
Lastly, we believe il is beneficial for health professionals in 
training lo be exposed to Hie turmoil, the Irustration and 
also the rewards of prison medicine if v>e hope lu alter the 
life-style of tin- imprisoned. 



References 

1. Robinson, D. Pri.suiu.-rs as I'ulienls. N t'ligl. J. Med. 
2M7MIM- lt!J, 1072. 

2. Lilt. 1. K.. anil Cohen. M. I. The Di uc,-L'sing Adoh-sceiil 
a» a Pediatric PaLiem. J I'cdiuli. 77 rib-- JUL', I'JTu. 

3. Lilt, I. I". Cohen, M I., .Schunheri;, !i Is d Spielund, 

I. Liver Dincisc in Ihe Oiu^-Using Adolesec-nl. U. IVihulr. 

«! :238— "J-12, 1072. 
it. Supirn, J. U. The Nai colic Addict as a Medical I'.ilienl. 
Am. J. Med. 45:55!>— Obh, IDiiK. 



PRISONS. AOOLEijClNtG. AMI MLDlCAL CAKl 897 



165 

HEALTH DELIVERY TO DETAINED ADOLESCENTS 
(By I. F. Litt, M.D.*) 

Medical care delivered to the quarter of a million children and adolescents 
residing in detention centers and training schools in the United States has heen 
found to be deficient in a number of significant ways. Admission medical his- 
tories and physical examinations are often inadequate or not performed, screen- 
ing tests are rarely performed, access to medical care following admission is 
limited and often arbitrarily determined, medical records are frequently unsatis- 
factory and doctor-patient relationships poor, according to a 1971 survey by the 
Academy of Pediatrics Youth Committee. 

This description would apply to the medical services which existed within the 
detention facility for juveniles for the City of New York prior to 1968. At that 
time, an affiliation agreement between the city's Office of Probation and the 
Division of Adolescent Medicine at Montefiore Hospital was signed and the pro- 
gram for upgrading of medical services for the inmates commenced. 

The three major components of the program for the girls and boys (aged 
10-16) in temporary detention for "delinquency" or "incorrigibility" were: 
quality patient care, training and health data collection. 

Service to patients consisted of in-patient care within a 17-bed Infirmary at the 
center, as well as in the In-Patient Adolescent Unit at Montefiore and an ambu- 
latory program for comprehensive admission screening and ongoing, easily acces- 
sible medical care to those in residence. 

The training program was designed to upgrade existing nursing staff, and to 
provide continual in-service upgrading to the nurses, pharmacists, technicians, 
dental and clerical staff. House staff and medical students rotate through the 
program for a minimum of four weeks to become conversant with the medical 
problems of this group, as well as to experience the dilemmas of health care 
delivery within a non-conventional setting. 

In the first six years of the program's operation, 37,000 patients have been 
evaluated. Forty-six percent of these presumably healthy teenagers were found 
to have medical problems, exclusive of dental or psychiatric conditions. The 
performance of screening tests alone (for hepatitis, venereal disease, sickle trait, 
tuberculosis, urinary tract infections and pregnancy) accounted for the dis- 
covery of medical problems in 7,026. There have been nearly 3.000 patients re- 
quiring admission to the Infirmary or the Adolescent In-Patient Unit, for treat- 
ment of infections such as pneumonia, salpingitis and cellulitis, head trauma, 
opiate or barbiturate detoxification or toxicity, metabolic problems such as dia- 
betes mellitus or thyroid disease, as well as surgical conditions such as hernia, 
undescended testicle or neoplasms. 

This experience of the Division of Adolescent Medicine affiliation with a youth 
detention facility has shown that, the detained population suffers from preexist- 
ing poor health by virtue of lack of medical care prior to detention and that 
certain medical conditions are by-products of the life-style of those who eventu- 
ally become incarcerated, as well as from the more usual illness of adolescents. 
Much can be done medically for detainees, even during a short period of remand 
and opportunities for epidemiologic surveillance of illness are great. Easy access 
to quality medical care also reduces tension and frustration within a prison-like 
setting. Lastly, we believe it is beneficial for health professionals in training to 
be exposed to the turmoil, the frustration and also the rewards of prison medicine 
if we hope to alter the life-style of the imprisoned. 



HEALTH CARE FOR JUVENILES ON PROBATION 

(By S. Kenneth Schonberg. M.D.**) 

The Division of Adolescent Medicine at Montefiore Hospital has been providing 
medical services at the Juvenile Detention Center in New York City for the past 
six years. Experience has revealed a greater than 50% incidence of medical 
problems. Despite the full range of medical services available at the center, the 



♦Assistant Professor of Pediatrics, Albert Einstein College of Medicine. Assistant 
Director. Division of Adolescent Medicine, Montefiore Hospital, New York, N.Y. 

** Assistant Professor of Pediatrics, Albert Einstein College of Medicine, Division of 
Adolescent Medicine, Montefiore Hospital, New York. X.Y. 



166 

brief period of detention precludes the full evaluation or treatment of over a 
third of these ill teenagers prior to discharge. The adolescent is often released 
into an environment where his delinquency, family disruptions and poverty, 
combined with a fragmented system of health delivery, all mitigate against his 
receiving further medical attention. 

The Adolescent After-Care Program was organized in 1972 in an effort to 
assure medical follow-up subsequent to discharge from secure detention. The 
program was staffed with a medical consultant, a coordinator, eight family health 
workers and a clerical staff. The medical consultant was chosen from the attend- 
ing staff already working at the Juvenile Center. It was planned that the project 
coordinator would be a social worker to insure that social services would be 
offered to the teenager while medical follow-up was simultaneously achieved. 
The family health workers were a diverse group, including housewives, ex- 
addicts and a former convict. They shared a lack of prior medical or social 
service experience. 

A three-month training period preceded acceptance of the first referral. 
Lectures, discussions, case reviews, and field trips were utilized. Subsequent to 
the training period, the program began accepting referrals from the infirmary 
staff. Problems requiring after-care included incompletely evaluated or treated 
medical problems, the need for continuing medication and chronic illness. Upon 
receipt of a referral, the medical consultant composed a letter to the family or 
institution describing the continuing problem, and prepared a medical summary 
including all facts pertinent to the teenager's illness. If the teenager had been 
discharged to a training school or other youth facility, the letter and the medical 
summary were forwarded directly to the placement institution. If the adolescent 
was discharged home, only the letter was sent. Medical summaries would then 
be available for release to any physician or health service designated by the 
family. 

[From the New York Times, June 1974] 
CENTER FOR BOYS IS CITED BY COURT 

U.S. JUDGE BARS EXTENDED ISOLATION AND USE OF DRUGS 

(By Arnold H. Lubasch) 

Several forms of punishment employed by a state center for delinquent boys 
have been barred by a Federal judge here. The punishments cited include placing 
youngsters in extended isolation, tranquilizing them with drugs and binding 
their bands and feet. 

Declaring that the delinquents have a constitutional right to rehabilitative 
treatment, rather than punishment, Judge Constance Baker Motley observed 
that they were confined as a result of civil Proceeding "without the full panoply 
of protections" that criminal trials would provide. 

Judge Motley's 2S-page decision, issued late Wednesday in Federal District 
Court here, resulted from a Legal Aid Society complaint against the Goshen 
Center in Goshen, N.Y., a special maximum-security institution for delinquent 
teenage boys. 

Citing the use of solitary-confinement rooms at Goshen, Judge Motley said that 
"boys have been placed in isolation for punitive reasons, despite the fact that 
such isolation cause", clearly anti-therapeutic hostility and frustration." 

The judge said that Goshen has used isolation to punish boys for minor 
offenses, that it had failed to follow proper procedures even when isolation might 
be warranted for violent behavior and that "except in the most extreme circum- 
stances, no boy should be held in isolation for more than six hours." 

SHOCKED BY TRANQUILIZATION 

Judge Motley found that the "most shnrkins;" violation of the state's own 
regulations at Goshen was the use of thorazine or other tranquilizing drugs, 
which nurses injected as a "punitive device." 

"In the view of this court," the judge added, "the use of thorazine may only be 
allowed as part of an ongoing treatment program authorized and supervised by a 
physician." 



167 

Assailin? the practice of physical restraint, Judge Motley observed that "hoys' 
hands and feet have Iven hound by handcuffs and plastic straps at Goshen for 
hours at a time." 

"They have been bound in this manner with a device connecting hands and feet 
behind their hacks," the judge continued, "and have been left lying on their 
stomachs on the floor." 

"The use of such physical restraints is highly antitherapeutic," the judge 
added, "and should be tolerated only in cases where a child is a serious and 
evident danger to himself or others and incapable of being controlled by any 
less restrictive means. 

"In no case should physical restraints lie utilized for more than 30 minutes, 
with the exception of vehicular transportation where there is a clear danger to 
public safety, and in no case should hands and feet be trussed together." 

NEW REGULATIONS NOTED 

A spokesman for the state's Division for Youth, which operates Goshen and 
several training schools for about 600 boys, said on Friday that new regulations 
had been adopted to guarantee the rights of youngsters in all these institutions. 

Mara T. Thorpe, a lawyer for the juvenile-rights division of the Legal Aid 
Society, which hied the original suit for Joe Pena and other boys at Goshen, said 
that Judge Motley's decision provided court enforcement of the state regulations. 

In the decision, Judge Motley said she was enjoining the punishment practices 
to prevent tb.3 state from reverting to them, even though the state had "appar- 
ently ceased many of the practices which amount to violations of the regulations." 

The judge noted that a new director had been appointed for the Goshen Center 
which now houses about SO boys, and that "significant strides toward improving 
the treatment of boys there have been taken." 



168 




The Legal Aid Society 

Juvenile Rights Division 

189 Montague Street 
Brooklyn, N.Y. 11201 

Charles Schinitsky attorneyin-charge 
Mara T Thorpe, ass t attorney-in-charge 
LeNORE Gittis, Aomin Attorney. pn-Charge 



Orison S. Marden 

Chairman of the Board 

Sheldon Oliensis 



President 



Harold H. Healy, Jr 



David N. Dinkins 



Secretary 



Telephone 
858-1 300 
858-3266 



August 6, 1975 



John Rector, Esq. 

Chief Council 

Senate Judiciary Subcommittee on 

Juvenile Delinquency 
A 504 

United States Senate 
Washington, D. C. 20510 

Dear John: 

As you requested, I am enclosing the following materials 
which may be relevant to the Subcommittee's inquiry into the 
use of phenothiazines on children: 

1. portions of the trial transcript in Pena v. New 
York State Division for Youth (S.D.N.Y. 70 Civ. 4868) 
together with a summary of the evidence on the use of 
thorazine and the preliminary statement from the post- 
trial memorandum, so you will understand what the case 
is about (the judge informed us last week that a 
decision is imminent) ; 

2. a copy of a stipulation in Pena (which was signed 
even though this copy does not so indicate) , paragraphs 
30 and 31 of which relate to use of thorazine; 

3. a copy of the New York State regulations governing 
use of medical restraints both prior and subsequent to 
the Pena trial; and 

4. portions of the transcript in Nelson v. Heyne 
relating to use of thorazine. 



The purpose of the Society is to render legal aid in the City of New York to persons 
who are without adequate means to employ other counsel. — By-laws of The Legal Aid Society. 



169 



John Rector, Esq. Page 2 

August 6, 1975 



I would greatly appreciate your notifying me when the next 
hearings are scheduled and when the transcript of the first 
becomes available. In the meatime, if I can be of further 
assistance, please don't hesitate to let me know. 

Sincerely, 



Mara T. Thorpe 



170 

S.D.N. Y. 70 CIV. 4 8*58 

Joe Pena, et al. 

v. 

New York State Division fob Youth, et al. 

May 30, 1974, 9 :30 am. 
Ms. Thorpe. We call Dr. Cole. 

Jonathan O. Cole, called as a witness by the plaintiffs, having first been duly 
sworn, was examined and testified as follows : 

DIRECT EXAMINATION BY MS. THORPE 

Q. Dr. Cole, would you state what your profession is, please? 

A. Yes. I'm a psychiatrist. 

Q. Have you been certified as a specialist in psychiatry by the American Board 
of Psychiatry and Neurology? 

A. Yes, I have, in 1953, if I remember — no — no, 19 — yes. 1953. 

Q. Do you hold any academic appointments? 

A. Yes. I am Professor of Psychiatry at Tufts Medical School and a lecturer 
at Harvard Medical School. 

Q. How long have you held those appointments? 

A. I have been a professor at Tufts for eight years, at Harvard for a year. 

Q. And prior to that were you associated with the Temple University Medical 
School? 

A. I had an eight-month flirtation with the City of Philadelphia in the past 
year during which I was Chairman of the Department of Psychiatry at Temple. 

Q. Are you associated with a psychiatric hospital? 

A. Yes. I'm a psychiatrist, strange, but it is the highest rank, at McLean Hos- 
pital in Belmont. 

Q. Have you also been affiliated with any institution which are specifically 
for juvenile delinquents? 

A. I was Director of the Boston Mental Health Foundation, a non-profit 
foundation with multiple functions, which was asked to run a program called 
Andros. The program was physically located at the Roslindale Youth Service 
Board facility in Boston and we were responsible for a program handling about 
40 of what were alleged to be the worst kids in Massachusetts under the Youth 
Service Board there. 

Q. Those were delinquents? 

A. They were delinquent kids, yes. The Youth Service Board there was trying 
to run things like that by contract and they needed an umbrella organization. 
I was somewhat involved with the running of Andros, but was not in day-to-day 
contact with the kids. 

Q. Within the field of psychiatry, do you have a subspecialty? 

A. Yes, clinical psychopharmacology. 

Q. Would you please outline for the Court your professional experience and 
affiliations which specifically relate to that field? 

A. Yes. 

From 1956 through 1967 I ran the Psychopharmacology Research Branch of 
the National Institute of Mental Health. This ended up a ten million dollar a 
year program of grant and contract research, the main purpose of which was to 
evaluate the efficacy and side-effects of drug treatment in psychiatry. 

Q. Have you received any awards for your work in the field of 
psychopharmacology ? 

A. One of the earlier studies we did was a nine-hospital study comparing 
chlorpromazine and two other phenotbiazines with dummy tablets, placebo, in 
the treatment of acute schizophrenics and this was a major study for which the 
American Psychiatric Association gave us a prize about ten years later. 

Q. Would you define chlorpromazine for the Court? 

A. Chlorpromazine is the first of now many antipsychotic drugs. It was orig- 
inally developed in France about 1950. 1952 and proved to be very useful in the 
treatment of acute and chronic schizophrenic states, remarkably more effective 
than previous treatments, though not absolutely curative, unfortunately. 



171 

Q. Is that drug commonly known as Thorazine V 

Q* Just to go back to your qualifications for a moment, have you published any 
books or articles in the field of psychopharmacology t 

A Ithinkl have 150 publications of one sort or another and have edited, 
thouch not written, probably eight books. 

M f Thorpe. Your Honor, instead of having the doctor run through such a 
list may I just hand up to the Court a list of the books and articles he has writ- 
ten after his testimony? 

The Court. Yes. 

Ms. Thorpe Thank you. , . . , 

Q. Have you conducted other studies of phenothiazines and more particular^ 
of Thorazine besides the one you just mentioned V 

A. Yes. I would guess I have been involved in planning and running probablj 
20 studies involving phenothiazines. 

Q What is the principal use of Thorazine in psychiatric practice .' 

A It's principally used for the treatment of schizophrenic states. 

Q. Are there any' other uses of Thorazine which you would say are profession- 
ally acceptable? , , n 

A. It's been well documented to be of use in severely agitated depressions. 

Q. Is that all? . . , ,. 

A. And beyond that it is occasionally useful— used in deliria. you know, medi- 
cal patients* getting very confused, and it is of questionable value in other 
conditions. ... 

Q. Are there adverse side effects which are known to be connected with 

Thorazine? 

A. Yes. On an initial administration early you can get a rather unpleasant 
drowsiness, useful in some cases, not in others ; a drop in blood pressure, sleepi- 
ness and a neurological side-effect known as dystonia in which your muscles 
usually around the face and neck go into spasm and you can —it will be illus- 
trated best by existing and freezing in position at a period of time. 

On other administration it can affect the liver and you can get jaundice which 
is usually not permanent or serious. You also get Parkinsonian symptoms with 
shuffling unit and cremor of the hands and drooling and mask-like face and you 
can get a restless leg syndrome in which the patient feels driven to keep moving 
around by some kind of discomfort of the muscles. 

A long term and of permanent neurological effect conditions representing 
Huntington's cholera can occur, but is usually found in patients who have gotten 
rather large amounts for rather long periods of time. 

Agranulocytosis or a severe drop in white blood cells can also occur rarely, 
on incidents like one in two thousand or something of that sort of patients 
treated, one in five thousand. 

Q. Is it possible to determine in advance if any of the side-effects which you 
have mentioned might occur? 

A. No. Dystonia is somewhat likely in younger people, Parkinsonianism is some- 
what more likely in older people. 

There is some relationship to dose, but it's not in any way clear. Sometimes 
you get severe side effects on low dosage and some people get no side-effects on 
high dosages. 

Q. How is Thorazine administered? 

A. Usually orally in tablets or elixir. It can be given intramuscularly. 

Q. Have the adverse side-effects which you have mentioned been found to occur 
when the drug is administered both orally and intramuscularly? 

A. Yes. You probably get more drop in blood pressure and more drowsiness se- 
dation with the intramuscular route because mainly you get a higher dose and 
it gets to the brain faster that way. 

Q. What would be the effect of a drop in blood pressure? 

A. It can be asymptomatic, no symptoms at all. the patient can feel very groggy 
and dizzy whenever he rises from a sitting or laying position, he can black out 
entirely and fall to the floor. 

Q. Would that be the equivalent of a state of shock? 

A. Yes. Shock is — if it were very severe it would be called a state of shock. 

Q. What are the physical and psychological effects of Thorazine orally? 



172 

A. It is probably less unpleasant for schizophrenics than for normal people, 
though it is not well documented. You know, people who are severely ill with 
schizophrenia don't give very clear accounts of themselves. 

We have run a study at Boston State Hospital in which we have been inter- 
ested in the effects of chlorpromazine on brain waves. In the course of this 
we planned originally to give 50 milligrams of Thorazine by mouth to normal 
college student type subjects on one occasion and give them placebo on another 
occasion and we hoped that everybody would get — some people would get placebo 
first and Thorazine second and some people would get Thorazine first and placebo 
second. 

We had to change the design, because all the normal subjects who got 50 milli- 
grams of Thorazine first refused to come back for a second try and we had to be 
double blind. We couldn't tell them they were going to get dummy pills the 
second time. It was clearly an unpleasant sedation that the subjects found in 
comparison to alcohol or sleeping pills. You feel funny and strange and discon- 
nected and not at all comfortable. Its subjective effects are clearly sedative, but 
they are not pleasant sedative. 

Q. What is the physical effect of intramuscular injection of Thorazine? 

A. In the first place, it hurts, it hurts at the site of injection. 

I can remember many years ago in the early days of Thorazine a friend of 
mine at Rockland State Hospital put patients on intramuscular Thorazine for 
the first week because he claimed that after having had a painful butt for a 
week they took the stuff by mouth much more cooperatively thereafter. So it is 
clearly unpleasant to get it in the butt. 

If you are a wildly excited schizophrenic you often get calmer and more 
sensible and clearer in your head. 

Q. Would you please explain the term P.R.N. ? 

A. My medical school is a little back. I think it says "Per registered nurse." 
but I could be wrong. Or as the thing is necessary. 

My Latin is bad. But it is understood to mean that medication could be given 
at the nurse's discretion under the specifications of the P.R.N, in order not to 
have the doctor to be recontacted. On the other hand, it is a when necessary 
order. 

Q. Defendants in this case have admitted in the pretrial order that it is their 
practice to obtain P.R.N, orders for intramuscular injections of Thorazine for 
every youngster upon his admission to Goshen, which you may assume for pur- 
poses of this case is the maximum security institution for male delinquents in 
New York. 

In your opinion, is this practice of obtaining P.R.N, orders routinely profes- 
sionally acceptable from a medical point of view? 

A. I'd say no. 

In the first place, I know of no good evidence that chlorpromazine is particu- 
larly useful in the usual conditions manifested by juvenile delinquents and, in 
the second place, I think that a drug of this sort should only be given intra- 
muscularly as part of a treatment plan and not as part of a routine boilerplate 
contract between — applied on all inmates by an institution. 

I must say in the 15 cases that I reviewed that you gave me all or part of, I 
was intrigued that no psychiatrist at any time in his note ever mentioned the 
intramuscular P.R.N, orders. Drugs were occasionally but rarely mentioned as 
part of a treatment plan given once or three times a day, but never was there 
any mention of P.R.N, medication as any part of any treatment plan. 

Q. That is in the psychiatric reports? 

A. Yes. And the orders in the charts were never signed by a doctor, to my 
knowledge. They were often T.O. or V.O. In one case I think a guy with a name 
beginning with a Z, there was an intramuscular dose given three months after 
the boy was admitted. It turned out in this unique case, it was the only one I saw 
with no standing order. So by medical standards, the dose was illegally given. 

Q. That boy's name is James Z. 

A. I believe that is the one. 

Ms. Thorpe. That is Plaintiff's Exhibit 4-56 that is being referred to. 

Q. Doctor, would it be acceptable by current medical standards to have P.R.N. 
orders for all children of any diagnostic class within an institution such as 
Goshen? 

A. No. 



173 

Q. Is it current medical practice to have such P.R.N, orders for all patients of 
any diagnostic class within a psychiatric hospital or ward? 

A. No. When I was Superintendent at Boston State Hospital such orders were 
never given, except when clearly psychotic patients were admitted and were 
very disturbed in their behavior. We would then have a — the order would then 
be written after the patient had been evaluated by the psychiatrist on call. 

Q. Doctor, is it standard medical practice to indicate in a patient's record 
why a P.R.N, authorization for Thorazine is given? 

A. Not absolutely. If the patient is known to be schizophrenic and is on a 
standard regimen of anti-psychotic drugs, one might write a P.R.N, order to 
increase the dose without making a special note in the record. 

When it is given not as part of a general treatment plan using phenothiazines, 
then I think it would require a note in the chart, yes. 

Q. Doctor, would the nature of any crime committed by a person ever con- 
stitute an adequate basis for this type of standing order in any type of 
institution? 

A. No, I don't think so, since crime and diagnosis bear almost no relationship. 

You get schizophrenic murderers and clearly well-organized non-psychiatric 
murderers. 

Q. Is it current medical practice to have P.R.N, orders for intramuscular 
injections for Thorazine for a person who is not also receiving anti-psychotic 
medication on a regular basis? 

A. I tell you, it's very unusual. 

Q. Why is that? 

A. Because it really is not indicated. I don't even know that Thorazine is 
useful in the control of — you know, assuming that people without schizophrenic 
or severe depression are agitated and upset, I'm not at all sure that Thorazine 
even has ever been — I'm sure it has never been shown to be clearly effective in 
non-psychotic non-agitated depression-type patients, so I'm not even sure it's 
useful. 

Q. Would the fact that a youngster is receiving anti-psychotic medication on 
a regular basis automatically warrant giving a P.R.N, order for Thorazine? 

A. Not necessarily, no. It makes it more understandable, but, again, it would 
be good medical practice and expected by the Joint Commission on Hospital 
Accreditation that there be a treatment plan that spells out such things which 
is updated regularly. 

Q. Who should give a P.R.N, authorization for administration of Thorazine, 
either orally or intramuscularly? 

A. Assuming the order was first — the order should first be written by a 
doctor. 

Q. That is the doctor who should first write it? 

A. An M.D. has to first irritate an order. 

Q. Is a nurse qualified to do that? 

A. She is not qualified to initiate the order, no. 

Q. Why is that? 

A. All state laws on hospital regulations that I know of require that the 
doctor write orders and the nurse merely carries out the doctor's orders. The 
nurse has some professional responsibility to carry them out intelligently, but 
she can do less than the doctor orders, but not more. 

Q. What you are saying is a nurse would not be qualified to increase a dosage 
previously prescribed by a doctor? 

A. Yes. If such a thing were done at hospitals I have been affiliated with, 
there would be an accident report written out, there would be an investigation, 
the nurse would be warned, chastised and so on. If it led to a severe event, she 
would be liable for suit and her license might be in jeopardy. 

Q. Would you say if a nurse did that that it would be a negligent practice on 
her part? 

A. Yes. 

Q. Would it be acceptable by current medical standards for a doctor who 
has never examined a youngster to give a P.R.N, authorization for intramuscular 
injections of Thorazine over the telephone? 

A. I would say no. 

Q. Why not? 

A. Well, he really doesn't know the patient, he hasn't looked at him. 



S3-303— 77 13 



174 

You know, I can't conceive of circumstances in which it is clearly impossible 
for the doctor to look at the patient, you know. You know, if you were running 
a satellite clinic in Outer Mongolia and there was no hope of ever getting a doc- 
tor near a patient because of eight feet of snow, you know, and one can conceive 
a situation where he really trusted the person who was giving him the informa- 
tion and he believed he had clearly good documentation as to the nature of the 
case and the problems, one could do it, but, boy, it is very borderline medical 
practice and I think it should be avoided wherever possible. 

Q. Assume for the moment that a youngster is acting out in a violent manner 
at the time that he is admitted to Goshen and no doctor is present, would you say 
that current medical standards would sanction the authorization of an intra- 
muscular injection at that point by a doctor over the telephone on the basis of 
the nurse's description to him of the violent behavior of the boy? 

A. No. No. I think the presumption is that a child admitted to Goshen is not 
schizophrenic, and, therefore, should be handled by non-pharmacologic means. 

If he is angry, which I can understand, the staff ought to do something about 
it. not sive him a shot. 

Q. What, in your opinion, would be the appropriate way to handle such a 
situation? 

A. It seems to me you have to try to work with the kid and talk to him and 
try to maybe ride him through a period of severely disturbed behavior with 
staff — application of staff, not drugs. 

Q. What do you mean by that? 

A. Have a staff member large enough not to be afraid of him spend time 
with him in an understanding, and, you know, interactive manner. 

Q. What are the minimum professionally acceptable criteria that should be 
used in making a P.R.N, authorization for intramuscular injections of 

Thorazine? 

A. I think the physician should have seen the child, patient, should have 
decided there is a medical condition which would respond to this medication 
and have signed the order. 

Q. In those instances in which Thorazine is appropriate, do you have an 
opinion as to whether it should be given orally or by intramuscular injection? 

A. I think intramuscular injection should only be used when the patient 
clearly needs the medication and is unable to take it by mouth. 

Q. Is it standard medical practice to make P.R.N, orders for the use of 
Thorazine orally and then only if refused by injection? 

A. I'm afraid not. I'm afraid it is not uncommon to find an I.M. It is not 
uncommon for a patient to be on oral medication and to have a standard P.R.N. 
I.M. order on the assumption that the order would only be used if the patient 
was badly out of control. Probably all orders should be written the other way, 
but they are often written like that. 

Q. Assuming that, the patient is not on ongoing anti-psychotic medication, 
would it be standard medical practice to write the order for oral administration 
and then only if refused, for an injection ? 

A. I think it's not standard medical practice to write P.R.N, orders for 
Thorazine in patients who are not on daily Thorazine medication. It is not a 
drug of choice for — for someone who is occasionally anxious, something like 
Valium would be more common. 

Q. What dosage of Thorazine should be prescribed in a P.R.N, order for an 
adolescent for the first time? 

A. I'd be inclined — if I thought it were indicated to start at 25 milligrams: 
and then repeat in an hour if necessary, rather than starting with 50. 50 mili- 
grams is not unusual as an initial dose. A hundred would be very high. 

Q. But in yonr opinion the initial — 

A. I would try 25 first. 

Q. Is there any relationship between the body weight of the patient and the 
appropriate dosage of Thorazine? 

A. No. No. Unfortunately, the amount required varies widely, yon know. 
Small schizophrenics take 1,000 milligrams a day and large ones get better on 
200. There ought to be some, but there doesn't seem to be. 

I might add incidentally, for controlling schizophrenic condition. I would 
not use Thorazine. I don't think it is the best of the available drugs. It was the 
first but. not 

The Cottrt. Excuse me. I believe yon testified as to the effect of Thorazine on 
someone who is schizophrenic. 



175 

The Witness. Correct. 

The Court. By saying it tended to make them more rational. 

The Witness. Yes. 

The Court. Have you told us the effect on someone who is not schizophrenic? 
What is the effect? 

The Witness. I think it makes them drowsy, sluggish, miserable, light-headed, 
uncomfortably sedated. 

The Court. For how long a period of time ? 

The Witness. Oh, probably on the order of six hours. Probably peak effect 
within 20 minutes after an intramuscular injection and probably detective effect 
lasting you know, somewhere between six and twelve hours, I guess. 

The Court. How long has this drug been in use? 

The Witness. It has been on the market in this country, I believe, since 1953, 
plus or minus a year. 

The Court. Have there been any studies as to the effect of long-term use of 
Thorazine? 

The Witness. Yes. Not as systematic as one would like, but there is a lot of 
evidence as to the effects of long-term use. 

The Court. What do those studies show? 

The Witness. You can develop a chronic neurological syndrome resembling 
Huntington's chorea with twisting movements of the mouth, tongue and hands 
and feet which does not go away very well. 

You can also get deposits of pigmented chemical material in the skin and 
eyes. 

In all fairness, this is usually after a much larger dose than I think any 
of these kids have received, but, yes, there are serious long-term effects. 

Q. Do minimal professional standards require that P.R.N, orders be reviewed 
periodically for the purpose of determining whether they should continue to 
stand on a patient's plan? 

A. The hospital rules vary a good deal in this respect, but somewhere between 
every week and every month orders, P.R.N, orders, should be reviewed and 
they are usually reviewed more frequently than regular everyday orders, which, 
you know, one month to three months, in my experience, has been the usual 
time. 

Q. Why should the review be made that often? 

A. Well, all orders are presumably related to the condition of the patient 
and the condition of the patient is likely to change over time. It cannot be 
assumed to stay constant forever. 

You know, I think one can argue that drugs like Dilantin for epilepsy or 
some of the oral anti-diabetic agents you could leave steady for quite a while, 
but even there you can get into toxicity and it is generally believed good medical 
practice to rewrite and, therefore, review all orders. It makes it clear that the 
doctor knows what is being given. 

One of the other things that happens is that you order one drug — you find 
it in state hospitals that are not too well run that a patient ends up with seven 
drugs, each of which was — one of which was added by a different doctor and 
nobody ever sat down and rewrote the whole set and saw what he was on. 

Q. For a non-psychotic child, would it be acceptable current medical stand- 
ards for a nurse to administer an injection of Thorazine under a P.R.N, order 
which had not been reviewed in more than a month? 

A. I think it is questionable in the first place and I think it is poor practice. 
It is even worse if the order hasn't been renewed. 

Q. What kind of behavior symptoms would the youngster at the institution 
have to have displayed to warrant a renewal of such an order? 

A. Let us go back to the first question, which is what kind of symptoms should 
he have emitted to justify the order in the first place. 

Really, my belief is that he should have shown clear symptoms of schizo- 
phrenia to warrant the intramuscular order in the first place, so I find it very 
hard to figure criteria for continuing. 

There are indications for a drug like chlorapromazine in children with be- 
havioral problems, but they are more restricted. 

There is some evidence of some benefit of Thorazine in hyperkinetic children, 
children with very short attention span and great distractability, usually younger 
than those kids, who are sometimes benefited by Thorazine. 

Q. What is the age range of the children you are talking about? 



176 

A. Like seven to twelve. And it is really for a specific defect, attention de- 
fect which interferes with schooling and should be — you know, the effect should 
be monitored by data from the classroom and from the kid's functioning. 
******* 

Q. Assuming that an injection of Thorazine has been administered to a 
youngster intramuscularly, are there any precautionary measures which should 
be taken afterwards? 

A. The practice varies. You can make a good case for taking blood pressures 
at, say, half-hourly intervals for two hours and keeping an eye on the kid for, 
you know, really shock-like business. 

In very hot weather in seclusion, I would recommend taking temperatures, 
because you occasionally — chlorpromazine can interfere with heat regulation. 
I have seen at least one patient go into heat stroke on chlorpromazine in a 
hot seclusion room. 

Q. Are there any special drugs which should be kept on hand to counteract 
any of the potentially adverse effects of Thorazine that you have mentioned? 

A. There is a commercial preparation of Norepinephrine that should be avail- 
able to counteract drop in blood pressure. The usual adrenalin does not work 
in chlorpromazine-induced blood pressure drop. 

Q. Doctor, I am showing you Plaintiff Exhibits 7-3, 7-5, 7-24, 7-26, 4-5, 4-aa, 
4-25 and 4-52. 

A. Yes. 

Q. Are those copies of materials that you have reviewed at my request? 

A. Yes. They look familiar, yes. 

Q. Do those materials contain both psychiatric material and medical records? 

A. Yes, they appear to. 

Q. In reviewing the psychiatric material and the medical records, did you 
find in those records any explanation for the P.R.N, orders for Thorazine which 
have been previously stipulated to exist? 

A. Nothing beyond the — you know, patient admitted in severely agitated con- 
dition, verbal order Thorazine I.M. That was the most detail I found. It was kind 
of half a sentence in the order sheets. 

Q. Is that an adequate explanation for issuing a P.R.N, order for Thorazine 
intramuscularly ? 

A. No. 

The Court. When you refer to order, that is something by a doctor? 

Ms. Thorpe. Yes. 

The Witness. Well, you know, it is written in a place where a lot of things are 
written and it usually says V.O. or T.O. Doctor somebody or other who does not 
sign it. 

Q. What would V.O. mean? 

A. V.O. I assume means verbal order and T.O. I presume means telephone 

order. 

A typical example would be 6/1/73, Thorazine 50 milligrams I.M. Q. 6 hours. 
P.R.N. T.O., meaning telephone order, Dr. Young, and then a circle with some- 
body or other and an A in it and I don't know what the A means. It may be 
somebodv's name in the institution who took the order. 

This is the kind of thing. This is a sheet which also contains notes like "patient 
had nosebleed" and other minor semi-medical things are recorded. 

Q. Are the materials on a boy by the name of David F. among those which 
you reviewed? 

A Yes. 

Q. Plaintiff Exhibit 1-1360 and 1-136A reads as follows : This is a memo to the 
A.C. from H. Holpolski. 

"During a.m. cleaning detail, David and another boy locked horns because 
the other boy — " excuse me. 

Ms. Thorpe. Do you object if I leave out the name of the boy? 

Mr. Hoffman. No. . 

q — "accidentally stepped on David's shoe. David was the aggressor m this 
incident and I recommend detention. 

1-136A reads, "To the A.C. from Joseph Bertholf. 



177 

"David gave us a hard time on Wing I this a.m. while in detention. He refused 
to take his belt off. I opened his door and he tried to rush by us to get out. 
Finally it was necessary to put him in restraints. I asked Mrs. Keer to give him 
a shot to calm him down. He was in plastic restraints approximately three 
minutes." 

Both of these memos are dated July 9, 1973. 

In your opinion, was the injection of Thorazine in that instance consonant 
with current minimum standards of the medical profession? 

A. I don't know that anybody has really written them for juvenile delinquents, 
but no, it is not consonant with — nobody has written clear medical standards for 
treatment in this kind of condition, but in my professional opinion and I think 
the majority of psychiatrists would not feel that Thorazine intramuscularly 
was appropriate as part of a limit setting punishment interaction with a child. 

Unfortunately, I don't think anybody has really decided what medical stand- 
ards should be in institutions of this sort. 

Q. Are the materials on a James Z. among those that you reviewed? 

A. Yes. 

Q. Plaintiff Exhibits 1-33 show that this boy was in room confinement on 
February 11, 1973 because he was involved in a plan to assault staff and run 
away from the institution. He was not released from room confinement until 
the afternoon of February 15, 1973. 

Exhibit 1-33A, which is dated February 14th, the fourth day of isolation, 
reads as follows : 

"Memo to the A.C. from D. Bertholf. 

"Periodic checks made and served breakfast. During the a.m. this boy was 
warned several times about noises he was making like a dog, pounding on the 
walls. This boy was so noisy he was put in restraints and given a shot. Served 
dinner. Continued making noise. Restraints had to be used and a shot ad- 
ministered by Mrs. Lunney." 

Then there are other notations about what else happened during the course 
of the day. 

In your professional opinion, was it appropriate to give the boy a shot of 
Thorazine because he was being noisy and pounding on the walls? 

A. No. Clearly inappropriate. 

Q. Did you review the materials on a boy by the name of Jeffrey B.? 

A. Yes, I did. 

Q. Exhibit 1-42A reads as follows : 

"Boy refused to wash up and put on his clothes this a.m. Boy was nasty con- 
cerning washing up. Placed in restraints, given injection by nurse and became 
very cooperative." 

In your opinion, was such a use of Thorazine consonant with current medical 
standards? 

A. No. The whole pattern of the cases I saw in all this was that there would 
be some kind of interaction between a boy and the staff, the staff would try to 
set limits and somehow or other in the middle of which I think may be appro- 
priate, but in the process of limit setting somehow or other Thorazine was in- 
voked as a magical remedy, you know. It may have been the final bad thing that 
happens to you. First you get taken to Wing I. then you get put into seclusion, 
then you get put in restraints and then if you are still making noise you get 
a shot. 

It strikes me it was for the peace of mind of the staff rather than for any 
treatment of the kids. 

Q. Have you also reviewed the materials on a boy by the name of William A. ? 

A. Yes. 

Q. Exhibit 1-75A, dated April 5, 1973, reads as follows : 

"Memo to A.C. from Mr. Speirs. 

"When William—" this is William Ashley, who testified on the first day of 
trial, so I will use his last name. 

"When Ashley was told he had gotten a poor on his conduct memo, he started 
banging on his door causing the lock to jam and when I couldn't get the door 
open he thought it was funny." 

The note at the top of this memo in different handwriting says, "9 :45 p.m. 
Placed in room confinement and given needle to quiet him after continued 
banging." 

Was that a proper use of Thorazine? 



178 

A. No. It seems to me these kids get put in solitary, they get mad at being put 
in solitary, they bang and then they got shots. What can you do? 

Q. On April 21st, the same boy was placed in detention for getting two poors 
on his conduct memo. 

Exhibit 1-S1B then states, 'Memo to the A.C. from D. Bertholf. 

"Ashley was placed in Room No. 2 detention. Within a half hour this boy was 
very belligerent and noisy, using profanity and pounding on the door. This boy 
was placed in restraints and given a needle. During the remainder of the a.m. 
the boy was quiet." 

It goes on to say when he was served dinner, etc. 

Was that appropriate? 

A. No. 

Q. Would the use of Thorazine in those two examples that I have read to you 
about William Ashley be consonant with minimum current standards of medical 
professional practice? 

A. No, I don't think so. 

Could I say something in addition? 

Q. Yes. 

A. At one point when things were very desperate at the Roslindale Youth 
Board service facility, which is right next to Boston State Hospital, I got called 
by the then Commissioner of the Youth Service in Massachusetts saying they 
had a riot on the'r hands of sorts, kind of a chronic I6wrgra.de riot in the deten- 
tion part, would I please send somebody over and give intramuscular Thorazine 
to eight ringleaders? 

A. I said, you know, no. I refuse to give Thorazine to somebody I have never 
seen in the first place. 

I did offer to take — everybody used controls in some way. I offered to take the 
two worst of course for evaluation at the psychiatric hospital partly to get them 
out of the situation and partly to cut down the conflagration at the other end, and 
that we did do. I didn't follow the kids to find out if they got any medication 
in our place. 

So I think it is inappropriate to give it for behavioral control and not for 
treatment. 

Q. Were materials on a boy by the name of John K. among those you reviewed? 

A. Yes, I believe so. 

Q. Plaintiff Exhibit 1-15S reads as follows : 

"John, along with the remainder of the wing, was advised about poor house- 
keeping at a wing meeting yesterday. All boys were advised to leave their rooms 
in good order when they left the wing. Upon inspecting the rooms when I came 
on the wing at 3 :00 p.m. John had the only disorderly room. He had dirty cloth- 
ing on his bed, also a shoe reposed there. His desk top was a mess. I pulled his 
bed clothing off of a disheveled bed. When he returned to the wing the boy 
inquired about his room. I told him that he had been warned about this yester- 
day and that he should put his room in order. He refused to do so and became 
upset about it. I took him to Wing I and advised Mr. Lewis of his refusal to 
follow my direction. 

"This boy has a very poor attitude. He apparently has been allowed to do as 
he pleased before coming to our school. With so many new boys in the group I 
feel staff should take a firm stand and insist that he follow routine." 

Exhibit 1-15SF, memo to the A.C. from Horan, dated the same date, which is 
September 26, 1973. 

"Student was brought to wing I by wing III H.C.C.W. because of a problem on 
Wing III. He was very argumentative and nasty. Student would not respond. 
Stated he would do what he wanted to do. He was told stand on Wing I until he 
got himself together and he became very nasty and refused to stand. He was 
placed in detention at 4 :15. When placed in detention he became rather loud and 
it was necessary for H.C.C.W. Lewis to speak to student once again." 

The last memo, Exhibit 1-15SG, same date, memo to the A.C. from Horan : 

"Student was placed in detention at 4 : 15 p.m. He then started to stuff blanket 
and pillow and shirt down the toilet. He then started to scrach his arms to make 
his arms bleed. Lewis spoke to student and he came down and was then checked 
by medical. When evening meal was served student refused to eat, then later 
refused to shower. At 8 :10 p.m., student started to scream and kick on the floor. 
Mr. Lewis and myself entered student's room and attempted to talk to student. 
He would not answer. We left room and immediately student started banging 



179 

furniture once again, knocked door. We re-entered the room and student had once 
again placed bedding in toilet bowl. Student was very upset, started screaming 
and yelling, made verbal threats to harm himself. Medication was given to stu- 
dent for his own protection." 

Given that whole series of events, Doctor, in your opinion, was giving the 
boy an injection of Thorazine appropriate action on the part of the staff? 

A. No. I think if they thought it was a real suicidal attempt, real suicidal 

thi-eat rather than a dramatic, you know, one more way of bugging the guards, 

then they should have specialed him. They should have had somebody with him. 

Seclusion, isolation is not a good treatment for suicidal attempts and I don't 

think that Thorazine would help. 

Q. Assuming that it wasn't a suicidal attempt for the moment but another 
reaction to being in isolation, would you say that it was appropriate? 

A. I still think putting in personal time with the boy is better than medication 
or isolation. 

Q. In your opinion, Doctor, should a non-psychotic youngster ever be given 
a shot of Thorazine for throwing furniture around the room? 

A. No. I think you ought to set limits by people, not drugs, and if necessary 
take the furniture nut of the room. 

Q. Doctor, Plaintiff Exhibit 4-50, I would like to read you the first entry 
on this medical card on a boy by the name of John V". 

•'Boy was admitted' to Goshen Annex on August 7, 1973." 

First entry dated August 7, 1973, "Lethargic and responding poorly on admis- 
sion. Seen by Dr. Holzer. Seen at 1 :20 p.m. Drowsy but fully conscious. Had 
Thorazine, 50 milligrams, 24 hours prior to coming to the Annex. At present 
some orthostatic hypotension. Pulse 101 over something I can't read, blood pres- 
sure 95 over 50. This boy does not need any special treatment at present, except 
bedrest until evening." 

Next entry dated, again, August 7, 1973, "Thorazine, 50 milligrams, I.M., 
agitation, Q. 6 hours, P.R.N. V.O. Dr. Holzer. Don't give any today or tonight." 
Doctor, in view of the fact that the boy arrived at the institution suffering 
from orthostatic hypotension, would you say that a P.R.M. order for 50 milli- 
grams of Thorazine intramuscularly was consonant with current medical 
standards? 
A. No. It's obviously consonant with institutional routine. 

A. It seems to me you should wait until the boy recovers from his previous 
medication and evaluate him. 

Q. I would bike to make clear, is orthostatic hypotension connected in any 
way with the taking of Thorazine? 

A. Yes. That is a common side-effect of chlorpromazine, drowsiness is also, 
so I suspect he had a prolonged reaction to his previous chlorpromazine. 
The Court. You mean he had previously been given Thorazine? 
The Witness. Yes. Apparently from the record he had gotten a shot at a 
previous institution to knock him out for transport to Goshen. 
The Court. And this — 

The Witness. It had not worn off at the time he arrived. 

The Court. And this orthostatic hypotension is a side-effect of the use of 
that drug? 

The Witness. Yes, a drop in blood pressure, like shock, only not as bad. It 
usually makes you feel dizzy, groggy, weak. 

Ms. Thorpe. Your Honor, the record here says he received 50 milligrams 24 
hours prior to coming to Goshen and then a P.R.M. order was entered into the 
record. 

i„>. Doctor, to go back for a moment to the Andros facility which you described 
in Massachusetts, that is a closed facility? 

A. Yea. Not as closed as it would like to be. Yes, it is a locked facility from 
which people occasionally escape. 

Q. And what is the sex and age range of the juveniles there? 
A. About 12 to IS, 12 to 17, all male. Oh, I think probably of the 40 kids, 
I think five had committed murder. It is the most severe kids in the state in 
terms of recidivism and seriousness of crimes. 
Q. Is isolation permitted at Andros? 
A. Very rarely used. Staff work with the kids. 



180 

You know, Jerry Miller may be talking about what he tried to do, but the 
staff there was about half ex-prisoners, and there was, in fact, some tendency 
for the staff to relate directly physically with the kids if necessary, but they 
had a good rapport with the kids but were also clearly able to set physical 
limits if necessary. 

Q. So isolation was not used? 

A. Isolation was not used. 

Q. Are non-psychotic youngsters ever given intramuscular injections of 
Thorazine when they act out or become violent at the Andros facility? 

A. No. 

Ms. Thorpe. I have no further questions at this time, your Honor. 

CROSS-EXAMINATION BY MR. HOFFMAN 

Q. Doctor, what did you mean when you said that the staff related physically 
to the boys at the Andros facility ? 

A. I think if a kid really tried to take on a staff member, the staff member 
would quietly subdue him. He would set limits personally. He wouldn't clobber 
him, but they had a group of staff strong enough to hold the kid while trying to 
relate to him. 

Q. So it was an accepted practice at that institution for the staff to physically 
restrain boys if they became violent? 

A. Yes. 

Q. And if you needed five staff members to do it, would five staff members 
restrain him? 

A. The policy, you know, unpleasantly presented to one of my psychiatrists, 
was to let the staff member fight it out on a one-to-one basis. 

Q. And did that occur on occasion? 

A. It apparently did on occasion. 

Q. You mentioned before that there was a riot at one of the facilities that was 
near the hospital that you were working at. 

A. Right. 

Q. Who was the person in charge of that facility ? 

A. I don't know. It was in the interregnum when Jerry Miller was trying to 
reorganize the institutions and I can imagine — you know, my scuttlebutt was that 
there was some dissention in the staff about the way Miller was changing things 
and they tried for a while having girls and boys in the same facility on separate 
locked wards, where they could look at each other and not interact with each 
other and funny things were going on. It was during a period of chaos. It settled 
down with new management and what-not. 

Q. And you offered to remove the ringleaders and take them to a mental 
hospital? 

A. I offered to have two kids evaluated, yes. 

Q. And was part of that offer to have an effect on the boys themselves? 

A. Part of the offer was to get them out, part of the offer was to look at them 
to see if they had any psychiatric illness. 

Q. Assuming that the institution cannot send boys to a mental hospital during 
a riot, what method would you prescribe to control the boys? 

A. I can conceive of situations where you have to isolate kids, you know. 

Q. "What situations? 

A. Clearly there is mayhem going on and you have to protect the kids from 
each other and from the counsellors. I can conceive of a situation about at the 
point where you call the state police where you have to isolate people to keep 
them from hurting each other. There is a point where everything is out of con- 
trol and you may have to do things like that. 

Q. Doctor, when a boy is trying to injure himself by banging his head against 
the wall or by pounding his fists into a wall until they start to bleed, what 
manner of restraint would you recommend in that situation? 

A. I would have somebody go in and work with him, two people if necessary. 
I would get him out into an area to exercise him a little bit, but I would try to 
work with him with people rather than walls. 



181 

Q. Let us assume the boy is very angry and he attempts to assault the people 
that are trying to work with him. What manner of restraint would you 
recommend ? 

A. I would still ride it out. He can't do it forever. 

I think it is a question of how much staff you have and how much time you 
have. Devoting two people for a half hour I think would get it in most cases. 
He would be down by the end of that time, particularly if they were viewed as 
relatively sympathetic. 

There is a problem^the Andros secret was that the staff was not viewed as 
bulls, they were viewed as working with the kids so they could set limits. When 
an impulsive kid exploded, they could set limits and be friends with him ten 
minutes later. It was a style of interaction. 

If Wing I people were viewed as sympathetic, they could handle it. 

Q. Would you recommend that the staff physically restrain the boy rather than 
using physical restrainers and medication? 

A. Yes. I don't think you ought to beat him up, but I think they should keep 
him from hurting people if they need to. 

Q. In your examination of the records of the boys at the Goshen Annex, have 
you observed that any boys suffered any adverse side-effects of Thorazine other 
than the case where the boy had been given the shot before he arrived at the 
institution? 

A. There was one boy that felt faint and dizzy a day after and I would have 
thought that was too late for a drug to be acting, but I have not observed many 
nonschizophrenics with a single intramuscular dose, and after hearing the other 
kid who still had hypotension 24 hours later, I suspect there is one other case. 
It is probably a long action. 

Coincidentally, since I became involved in this, I was talking with another 
expert in psychopharmacology who took a large dose of Thorazine himself and 
said he didn't feel right for three days, so my estimate as to the duration of 
action may be low. 

Q. What would you define as a large dose? 

A. I think he had either 50 or 100 milligrams. 

Q. Would 25 milligrams be considered a small dosage? 

A. Yes. 

Q. When you were speaking before about the long-term effects of Thorazine 
on a person's nervous system or other side effects, what order of magnitude of 
dosages were you talking about? 

A. Usually those occur in patients who have been in a state hospital for ten 
years. 

There are occasional cases — I know of two individual cases of people with 
pre-existing brain damage — no, a girl who had a stroke, a young girl, who de- 
veloped permanent apparently serious neurological consequences after, you 
know, three weeks' treatment, so it can occur with less, but it's very rare. 

Q. What was the order of magnitude of the dosages and what was the fre- 
quency of the dosages? 

A. I don't remember, but she got routine doses of Stellazine, a drug like 
Thorazine, for a month, maybe. I would guess it was eight milligrams a day, 
but it would be the equivalent of maybe 200 milligrams of Thorazine a day. 

Q. Would it be true that an occasional injection of 25 or 50 milligrams of 
Thorazine on a teen-age boy would produce any long-term effects? 

A. I think it's very unlikely, but conceivable. 

Q. Assuming that a boy had been given Thorazine at an institution prior to 
his arrival at Goshen and his medical record indicated that he had not suffered 
any adverse side-effects at the previous institution, unlike the case that you 
spoke about, would there be less danger in prescribing injections of Thorazine 
for highly agitated behavior? 

A. Probably somewhat less if the kid had been — was on maintenance oral 
treatment, if he had been on pills every day before transfer and again after 
transfer, then the impact of intramuscular — his system would be somewhat ac- 
customed to Thorazine and his reaction would probably be somewhat reduced. 

Q. If a boy has been given one injection of Thorazine and has suffered no 
adverse side-effects, can one make a prediction as to the possibility of side-effects 
from a future injection? 

A. Yes, probably less, but there are still variation in boys' state and in the rate 
of absorption from different spots and injections. 



182 

You know, it is possibly — it is obviously somewhat less likely to occur if a 
previous injection has not bad bad effects. 

Q. When you speak of current medical practice, would you define more fully 
what you mean by that term? 

A. Talking about what I would consider proper in psychiatric hospitals or 
wards with which I have been affiliated more recently, Boston State Hospital, 
Temple University State Hospital, McLean Hospital in Boston and other state 
hospitals in Massachusetts. 

Q. Would it be true in these institutions that a drug like Thorazine would be 
administered perhaps on a daily basis and on much higher dosage levels than 
administered in this case? 

A. Certainly. 

Q. Are there any current medical practices with respect to juvenile institu- 
tions or similar institutions? 

A. I know of no standards for juvenile institutions of the sort of Goshen or 
Andros, for that matter, that have been written by anyone. 

Q. So that a psychiatrist who prescribed the use of Thorazine at such an 
institution would not be prescribing medication that was contrary to any current 
medical standards involving those institutions, is that right? 

A. If the institutions have no standards he obviously cannot be prescribing it 
against its standards. On the other band 

Q. I didn't mean the institutions' standards. 

A. I think there are standards of general practice. If a similar kid were ad- 
mitted to a psychiatric hospital for evaluation and treatment and there is ob- 
viously some overlap between, you know — relatively richer kids that end up at 
McLean and relatively poorer kids who end up in the juvenile delinquent system 
have something in common in psychopathology. 

No, I think the standard would still be that chlorpromazine is a crazy drug to 
use on kids whose primary problem is personality disorders, asocial or anti-social 
personality gang delinquent or individual. 

Q. Is there an isolation unit at McLean Hospital? 

A. There are individual 

The Court. I can't hear you, Mr. Hoffman. 

Q. Is there an isolation unit at McLean Hospital? 

A. There are — McLean actually has closed its two disturbed wards and han- 
dles patients. Patients do get put in seclusion, but they do that in individual 
quiet rooms on individual wards. 

Q. How long do they stay in seclusion? 

A. With being brought out every couple of hours, they can stay for several 
days. 

Q. And is that an accepted medical practice? 

A. I don't like it. 

Q. That wasn't my question. 

A. You know, it is a borderline medical practice. 

I have only been there three months and I'm not in charge of that part of it, 
but I am going to try to work to change it. I think they use seclusion more than 
they should. 

Q. Do you see a use for seclusion at the institution? 

A. If you simply cannot afford the staff to handle the patient in better ways, 
then I suppose you have to use seclusion occasionally. 

I find it, you know, an unpleasant, generally unuseful and occasionally lethal 
form of treatment. People die in seclusion for reasons other than drug treat- 
ment, and in Boston State where I tried to keep seclusion down we had, to my 
knowledge, five deaths in seclusion in five years. So people do commit suicide in 
seculsion and especially in people who are — or they die of heat stroke, funny 
things happen, so I really don't want to get — I am ashamed to admit that McLean 
uses it as much as it does. 

Q. Doctor, are the members of your profession in unanimous agreement about 
the use of seclusion rooms and time-out rooms? 

A. T doubt that the members of my profession are in unanimous agreement 
about anything. 

No. I think there is a general belief, strongest by those who don't have to 
work directly with patients, with that kind of patient, that seclusion is very 
bad. but even people who run hospitals and work on wards, many of them feel 
very strongly that they use it only when all else fails. 



183 

Q. Doctor, is there any typical restraint that could be used to calm an agitated 
boy other than the use of Thorazine? 

A. Yes, one could consider something like Valium, one of the anti-anxiety 
drugs could be tried. 

You know, nobody has studied drugs in this situation and, therefore, there is 
no good basis for practice and current attitudes toward doing drug experiments 
on prisoners and other people with limited right to give consent is not likely to 
increase our understanding in these matters. I guess I would try Valium if I 
had to try something or sodium amatol. 

Q. Would Valium have to be administered orally ? 

A. It could be administered either way. 

Q. Has it been your experience that a violent boy or a violent patient will 
accept oral medication during moments of violence? 

A. Probably not. I think the time given to get them to accept oral medication 

no, under threat, if he is not too far out of control, you may be able to talk 
him into it. 

Q. What threat would you use? 

A. That is the question, you know. Either you take the medication or you go 
into restraint might occasionally penetrate a kid who is not too fighting mad. 

Q. And what restraint would the kid go into? 

A. I don't know what you've got a Goshen, but I gather they have 

Q. What restraint would you use if he refused to accept medication? 

A. I would not use restraint. I would try to get staff to stay with him. 

Q. Just hold him down? 

A. Hold him down, talk to him, you know. Get him in a large enough area 
so he doesn't feel crowded and give him a — I think a gym if I had one and give 
him a punching bag or something or other. I would try to give him some physical 
relief without crowding him so closely that he would blow up staff. 

Q. If he was put in a room with a punching bag, would that be helpful? 

A. Yes. That is used in some hospitals. 

Mr. Hoffman. No further questions. 

REDIRECT EXAMINATION BY MS. THORPE 

Q. Doctor, when you say if a boy were threatened he might take the oral 
medication, if he were given a choice between receiving the medication by needle 
or orally, in your opinion, would he be likely to accept the oral medication? 

A. Yes. unless he thought that the needle was fun in some way. He would take 
the oral if given a choice. 

In fact, many of these things by the time it gets to the medication point every- 
body is so mad at everybody else that you can't do rational bargaining. 

Q. And you say it might be appropriate in some instances to put him in a room 
where there was a punching bag. How long would you estimate that it would be 
necessary to leave him in there with the punching bag before he calmed down? 

A. I would suspect most of these things are over in 15 to 20 minutes. I don't 
know. 

If the kid is locked up and angry about being locked up, it can go on for a long 
time, but my impression is that most acute emotional outbursts tend to taper 
off if not prolonged by barriers or aggravations. 

Q. When you say it would lie useful to put him in a room with a punching 
bag, would you say that the door would have to be locked in order for him to 
work out his aggression on the punching bag? 

A. No, no. I would try to get him to do something where he didn't feel hemmed 
in and could get rid of some of his energy and might — which he might view as 
being good. Try to get him to do something that he would think was good rather 
than bad, and if I were to set limits I would probably punish in some other way. 
I think maybe it is easier to withhold desserts. 

I think setting limits and having consequences of behavior is important, but 
if they go beyond a certain point, and one of my objections to seclusion is that it 
takes a long time, it doesn't necessarily teach a lesson and it is a consequence 
which doesn't shape behavior very well. 

Q. Is there a difference between seclusion for psychotic children and seclusion 
for non-psychotic children? 

A. I suspect in — at Goshen I suspect that seclusion was used more as punish- 
ment than psychiatrists like to think it's used as. 



184 

Tmi know if you were trying to medicate an acute schizophrenic and get him 
nnde? control you cJn see seclusion as a way-statiw while the medication was 
working -To keep him from hurting himself or others. This is a little less clear in 

^Tr^ther'Sfnrthere are programs in psychiatry in which there is sort of 
beh^ior mociflcat on where you get an hour in seclusion if you do A, you get 
two hours 5 you do B, you get three hours. You have a contract in advance With 
the oatient that certain amounts of behavior leads to seclusion. 

I don't know that it works. That is rational if not desired treatment. 

Q. That is a carefully formulated program i 

Q But vou spoke of seclusion patients at McLean Hospital for periods of two 
hours, taking a patient out and perhaps putting him back in. 
A Yos. 
Q. Are those psychotic patients you are speaking of? 

A Yes. 

o' Would that happen with non-psychotic patients at McLean? 

A I suspect it occasionally has happened when there is a real uproar in the 

wards and the patient is cut of control. I am afraid I would say yes 

Q. Would you say most of the practice of seclusion is for psychotic patients .' 

A Yes. 

Q When you say it may be necessary to use seclusion if there is a shortage of 
staff, are you looking at that from the point of view of the institution's needs or 
from the point of view of the child's needs? . 

A Well, it is very hard to discriminate. What I as saying is given the not 
that we were talking about in which there is group violence threatened to staff 
and people are barricaded on both sides of a wall and negotiate, you know, every- 
thing has fallen apart, then you may need for everybody's sake to get things sep- 
arated out somehow or other. But it is probably to the institution's more than 

the kids. . . 

Q. So for the children, forgetting the institution's needs for a moment, for 
the' children would you say it was therapeutic or anti-therapeutic? 

A. It is probably anti-therapeutic for them to get away with the riot. Some 
limits have to be set somewhere. 

It would be great if you could find a better way out of the situation than a 
head-on brute force clash, but where a totally disordered situation in which 
everybody was fighting, you've got to separate them. 

You know, police action like in mobs, you may agree that Viet Nam is bad, 
but a riot that occurs in the middle of an anti-Yiet Nam demonstration has to 
be settled somehow or other. It may be settled well or badly, but there are times 
when police action is probably appropriate. It is probably police action rather 
than treatment. 

Mr. Thorpe. Thank you, Doctor. 

Edward Kaufman, called as a witness by the Plaintiffs, being first duly sworn, 
testified as follows : 

DIRECT EXAMINATION BY MS. THORPE 

Q. Dr. Kaufman, what is your profession? 

A. I am a physician and a specialist in psychiatry. 

Q. Where did you receive your residency training in psychiatry? 

A. Columbia Presbyterian Hospital and the New York State Psychiatric 
Institute. 

Q. Have you been certified by the American Board of psychiatry and Neu- 
rology in psychiatry. 

A. Yes. 

Q. Have you completed training as a psychoanalyst as well? 

A. Yes ; at Columbia Psychoanalytic Institute. 

Q. Do you presently hold any academic appointments? 

A. Yes. I am a collaborating psychoanalyst at the Columbia Psychoanalytic 
Institute and a Clinical Professor at Mount Sinai College of Medicine. 

Q. Have you held other academic positions in the past? 

A. Yes. I have previously had academic positions at Albert Einstein College of 
Medicine and at the College of Physicians and Surgeons of Columbia University. 



185 

Q. Have you also been associated with the New York State Psychiatric 

Institute? , ,. ,< -. 

A. Yes. Besides my residency training there for one year, I was the director 

of an in-patient unit. 

Q Have you worked as a psychiatrist in any prison systems? 

A Yes I was the chief of psychiatric services at the Lewisburg Penitentiary, 
and I was the director of prison health services for the New York City prison 

system 

Q And at the present time, do you have any other professional responsibilities? 

A Yes. I am the chairman of the American Psychiatric Association district 
branch committee on prisons, and I am the chairman of the Columbia Psycho- 
analytic Association's committee on psychoanalysis and community psychiatry. 

In addition, I am employed as the chief psychiatrist at the Lower East Side 
Service Center in New York City. 

Q. Dr. Kaufman, have you visited the Goshen Annex? 

A. Yes. 

Q. When was that? 

A. April 16th of this year. 

Q. Did you make that visit at my request? 

A. Yes. 

Q. Did you visit Wing 1 when you were there? 

A. Yes. 

Q. Did you inspect the isolation rooms in Wing 1? 

A. Yes. 

Q. Now, I show you Plaintiffs' Exhibit 5-1 in evidence which are photographs 
of a room on Wing 1. Is this a picture of one of the rooms which you saw? 

A. Yes. 

Q. Is there any difference between the room pictured in that exhibit and the 
rooms that you saw? 

A. Well, at least two of the rooms I saw had a picture drawn on the wall, 
which I guess could best be described as psychedelic art, and I don't see those 
pictures there. 

Q. Describe further what you saw on the walls when you were there, please. 

A. Well, it's a — the one picture that stands out in my mind was that of a 
face, multicolored, with a kind of distorted, disturbed expression on the face. 

Q. Did you examine any of the boys who were confined at Goshen? 

A. Yes. 

Q. How many did you examine? 

A. Three. 

Q. Did the institution make available to you the case files for each of the boys 
you examined? 

A. Yes. 

Q. Did you review the case file, each case file, in connection with your exam- 
ination of each boy? 

A. Yes. 

Q. Now, I show you Plaintiffs' Exhibit 7-7, Exhibit 7-8 and Exhibit 7-9 
marked for identification. Please look at them and tell me if they are copies 
of the portions of the material which you examined. 

A. I have seen all of these before. 

Q. Doctor ■ 

The Court. You said it was not a prison, Doctor. What do you mean by that? 

The Witness. Well, I don't believe that it is legally 

The Court. You mean they are free to leave? 

The Witness. No. I think I said "prison" as a slip, because I basically ex- 
perienced it as a prison, but I think it is not actually termed a prison. It is a — 
what is it called? State school? 

Ms. Thorpe. Training school. 

The Witness. Training school. 

Q. Now, Plaintiffs' Exhibit 7-10, which has been previously marked for identi- 
fication, indicates that Vincent was held in isolation on April 15, 1974 for a 
period of seven hours and fifty minutes. 

A. Yes. 



1S6 

Q. Now, you testified that you were there on the 16th of April, so that it is 
the day before your visit. 

A. Right. 

Q. As a result of your examination of Vincent, did you make any findings as 
to the effect on him of being held in isolation? 

A. Yes. My feeling was that it was basically a disturbing experience for him, 
that particularly when the door was first locked it made him become much more 
disturbed, and it made him feel much more out of control, so that he started 
banging his head at that point. 

A little while later, he became very depressed, and he had thoughts of sui- 
cide. He actually contemplated hanging himself with some shoelaces which he 
said were in the room at that time. 

So that basically it was a disturbing experience for him, which excited him 
more and made him go out of control rather than quieting him down. 

Q. On the basis of your examination of Vincent and review of his record as 
well as your training and experience, what is your opinion as to the conse- 
quences of those effects for his treatment or rehabilitation? 

A. That basically they are antitherapeutic for him, that they tend to increase 
his anger and his hostility toward the institution as a whole, that they tend 
to impair his ability to participate in treatment programs in the future, that 
they impair his sense of autonomy and his — impair his urges toward self- 
reliance and self-development, that, for instance, after he quieted down they 
may have induced some temporary ability to handle himself but that in the 
long run they probably bring about a lot of hostility and give him a feeling of 
depending on controls from the outside rather than developing his own sets 
of controls. 

Q. Now, Doctor, Plaintiffs' Exhibit 1-141B, dated August 3, 1973, reads as 
follows — it is a memo to the A. C. from James Larsen, pertaining to this same 
boy, Vincent P. : 

"This boy has not responded to supervision today. He runs his mouth and does 
not listen to anything you say. Boy picked up two bad logs, one for kicking 
basketball and the other for coming out of his room without permission." 

Now, Exhibit 1-141C in evidence is dated the same date, August 3, 1973, to 
A. C. from Mr. Dean : 

"Student placed in detention per HCCW. At 9 :30 student became violent and 
abusive, attempting to break up room by kicking and banging on door, uttering 
profanities, in so doing. At 9 :35 student placed in RC and given medication to 
cahn him." 

Now, Vincent's medical card, which is Exhibit 4-40 in evidence, shows that the 
medication given was an intramuscular injection of thorazine. 

Exhibit 1-141 shows that the boy was in room confinement for twenty-two and 
a quarter hours as a result of this incident. 

The Court. What date is that? 

Ms. Thorpe. This is in August of 1973, your Honor. 

Q. [Continuing.] In your opinion, was placing Vincent in isolation an appropri- 
ate response on the part of the institution from the point of view of his treat- 
ment needs in that instance? 

A. I don't think so. I think that what it does is, it sort of communicates to him 
that people are not capable of really dealing with him, of not really understand- 
ing what is going on and that they are sort of giving up and locking him up be- 
cause they really don't know how to deal with him at that point. 

Q. Doctor, if an epileptic becomes emotionally upset, is there an increased risk 
of an epileptic seizure? 

A. Yes. There certainly is. 

Q. Now, Plaintiffs' Exhibit 1-174B pertaining to the same boy reads as fol- 
lows — it is dated November 24, 1973, and it is a memo to the A. C. from B 
Simpson : 

"This a.m before anyone was called up to recreation, Vincent came out of his 
room with a lot of lip service. When I told him to get back in his room he told 
me to go to hell." 

A note at the top of the memo, "Placed in detention at time he verbally at- 
tacked Wing 1 staff and refused to comply with detention regulations." 

I am sorry — I can't read the rest of it. 



187 

Now, Exhibit 1-174-C of the same date reads as follows— it is to 
Mr. Kozykowski : 

••When I returned to the wing after bringing"— another boy— 'to see you, 
Vincent had trouble with Mr. Simpson, even telling him to go to hell. He asked 
me how long he had to stay in his room, as he couldn't fight it. I told him he had 
to square himself with Mr. Simpson. Then he said Mr. Simpson was a trouble 
maker. I then called Mr. Ferarra to come and get him." 

Exhibit 1-174-D of the same day, a memo to the A.C. from PRB, reads : 

"11 -05 placed in R.C. 11 :30, chair and desk removed from room. Student threw 
chair admittedly with arrogant attitude. 11 :50, student banging on door con- 
tinuously after being placed in restraint and shot administered by nurse to calm 
student down. 12 :05, restraints removed." 

And then it goes on to talk about the rest of the day. 

Now, Exhibit 4-^0, which is Vincent's medical card, again indicates that the 
shot administered by the nurse was thorazine. 

On this occasion, Plaintiffs' Exhibit 1-174 shows that the boy was held in 
room confinement for twenty-six hours. 

In your opinion, was placing Vincent in isolation an appropriate response on 
the part of the institution from the point of view of his treatment needs? 

A. Again I would have to say no. I think that in addition to the similarities 
between this and the previous incident, that is, that it confirms that it is difficult 
for him to establish his own controls and that he requires other controls on some 
of the other things that I have mentioned. 

It is also an example of how situations are escalated through a lack of thera- 
peutic interaction might be able to solve it, and they continue to escalate until 
the boy is on the verge of going out of control, and then he is placed in isolation, 
and then once again the isolation serves to disturb him further rather than 
quiet him down, that it makes him go out of control. 

The Court. What is this going out of control? I don't understand that. Several 
witnesses have used that. The term has never been defined. What is this going 

out of control? 

The Witness. Well, for him it is banging his head on the door. It is picking 
up the chair and throwing it aganst the walls. It is, you know— it is not being 
capable of communicating rationally but rather only capable of flailing out help- 
lessly and perhaps destructively. 

The Court. All right. 

Q. Doctor, in your opinion should isolation ever be used for Vincent, specifically? 

A. Well, I think that situations could be avoided so that this kind of escalation 
did not occur, so that the situation should never exist that isolation should have 
to be used for him, that situations can be avoided which provoke him to a point 
where he is seemingly out of control. 

Q. Could isolation ever be a therapeutic experience for him? 

A. I think that it might be, for a very short period of time. 

Q. How short a period of time? 

A. Half hour to an hour. Maybe even — maybe fifteen minutes. 

The Court. What do you mean by "therapeutic" in that sense? 

The Witness. Well, I think that I could conceive of a time where his being 
placed in a room like that might help him establish controls. I would also want 
to try to resolve the solution through interaction with another human being. 
You know, I would prefer to have somebody sitting in the room with him. I am 
not sure if that would be called isolation or not at that point. But if he were to 
be in that room, I think the effect of someone going in the room and being with 
him could frequently help him establish controls. 

Q. All right. So you are not talking, then, about being confined alone in a 
room, but you are talking about having somebody with him, away from, say, 
the peer group in the institution? 

A. Yes. 

Q. In reviewing Vincent's case file, did you find any individualized treatment 
plan which had been formulated for him which incorporated a plan for the 
utilization of isolation? 

A. No ; there was no treatment plan that discussed the use of isolation in 
his case, at all. 

Q. Did you find any treatment plan formulated for him? 



188 

A I didn't find what I would consider a treatment plan, that is, I didn't find 
some attempt to gather data from all of the people who had been working with 
him in the institution and pulling that data together so that there was a general 
synthesized treatment plan that everybody could agree on and that everybody 
could follow through on. 

There were some treatment recommendations, however, that I did read in his 
file and they were generally very brief and dealt quite generally. 

I could read three of them. They are each one sentence long. One, on 10/12/73 : 
"He needs constant reassurance, redirection and support." 

Another, on 12/12/73: "He requires a lot of emotional support, understand- 
ing and acceptance." . . 4i+v . . . 

And a third, by a Mr. Nelson— I could not find the date : "He will need firm- 
ness, gentle but not overprotective." 

Q. In your opinion, would placing Vincent alone in a room be consonant with 
any of the treatment suggestions that you found in the record? 

A. No. I felt that it would be the opposite. 

Q. Was a boy by the name of Fred R. one of the boys that you examined? 

A. Yes. 

Q. And that was on April 16th that you examined him of this year? 

A. Yes. 

Q. What was the diagnosis of Fred? 

A. An adolescent adjustment reaction with a possible underlying schizophrenia. 

Q. In your opinion, is Fred a boy who is in need of treatment? 

A. Yes. Here, too, Fred is someone who has a great deal of difficulty in getting 
along with his peers. I think he has somewhat less in the way of overt anxiety 
than Vincent. He has a lot of difficulty in some of the basic social skills and in 
being able to function, for instance, a school situation. He also has some tendency 
to withdraw from reality and to have a hallucinatory kind of experience. That 
is that he hears voices that are not there, and this can be an ominous sign that 
there is a very dangerous, difficult underlying schizophrenic process that may 
become manifest later. 

Q. Plaintiffs' Exhibits 7-11 and 7-19. previously marked for identification, 

which have been shared with Mr. Hoffman, show that between February 20, 

_1974 and February 24, 1974, Fred was confined to a room on Wing 1 as follows: 

On February 20*, 1974, he was in detention status for seven hours for profanity 
to a teacher. 

On February 21, 1974. he was placed in isolation at eight a.m. for "school prob- 
lem of 2/20". the day before, for seven hours. At three o'clock, his status was 
changed to Wing 1, and he remained in the isolation room until 6 :40 p.m., when 
he was allowed ont to watch TV for one hour and twenty minutes. 

At eight p.m. he was returned to his room and was not out of it again until 
5 :45 p.m. on February 22nd. the following day, to shower and watch TV. 

He was returned to his room at eight p.m. and remained there until close to 
one-thirty p.m. on February 2Gth, when the following incident took place. This 
is Exhibit 7-16, marked for identification. This is a memo dated February 23rd, 
a memo to the AC from P. R. Berthoff. 

"Student came out of room, requested to see his social worker. When I ex- 
plained that there were nr> social workers working, boy came out of his room 
and sat on the bench. At this point, I went down to talk with Fred, but he was 
unreceptive and started to walk up the hallway to leave Wing 1. Mr. Salada 
stood in the hallway, at which point student told him to move. The second time, 
the student pushed Mr. Salada and made the statement, 'Go ahead and hit me.' 
and pushed him again, at which point both Mr. Salada and myself grabbed 
student to restrain his aggressive action. Proceeded to take Fred to his room, 
where he subsided himself momentarily ; then he thrust his knee up in 
Mr. Salada's groin, at which point student was placed in bed, and Mrs. Lunney 
administered a shot. Student continued, and restraints were placed on student. 
"Tried to speak with Fred, but he was very negative and threatening, stating 
he would get even. He was then confined to his room for the remainder of Feb- 
ruary 23rd. and on February 24th until 1:50 p.m., when he was permitted to 
watch TV for one hour and ten minutes. 

"He was allowed to watch TV for another fifteen minutes between eight and 
eight-fifteen p.m. and then confined to his room until 8 :30 a.m. on February 25th, 
when he went to school." 



ISO 

Now, that is a period of, roughly, ninety-eight hours in isolation in a five-day 
period. Did you discuss this period of isolation with Fred? 
A. Yes ; I did. 

Q. As a result of your examination of him, did you make any findings as to 
the effect of this period of isolation on him? 

A. I felt that it was one which was very disturbing to him. It increased a lot 
of his angry and aggressive thoughts to the people, to the workers in the insti- 
tution, but also it made him think of a lot of his anger at his own father. 

He experienced some feelings of going crazy in there, which he was — he did 
not actually go crazy, but he felt like he was going to go crazy. On this particular 
time he did not report any auditory hallucinations in isolation. However, he did 
discuss with me that on a previous time in isolation he had had adultery haluci- 
nations, so that I felt that here again an incident which started out as a relatively 
minor one, that is, some school problems, escalated into his being put into isola- 
tion and then his being put into isolation escalated into a pretty difficult kind 
of physical encounter. 

I think that this certainly must have had a very strong effect on alienating 
him from therapeutic effort. 

Q. Now, in your opinion, would isolation ever be therapeutic for Fred? By 
"isolation" again, I mean confinement alone in a room. 

A. It should never be necessary. The situation should never be escalated to 
the point where that is needed, and, again, it is something that always should 
be able to be worked out with him being with one person in a room, particularly 
someone that he trusts and has a therapeutic feeling towards. 

Q. In yomr opinion, would subjection to isolation help or hinder Fred's rein- 
tegration into the community upon his release? 

A. Well, I feel it would hinder it. I think it increases his hostility, and it also 
does not help him build inner controls. It emphasizes outer controls. 

Q. In reviewing Fred's case file, did you find any individualized treatment 
plan which has been formulated for him which incorporated the plan for the 
use of isolation? 
A. No. 

Q. Did you find any treatment plan at all? 

A. Here I found much less of any kind of treatment recommendation than I 
did in the previous case. There was one statement which was a therapeutic 
recommendation, which was made by Dr. Sawi, which I will quote: 

"I think that psychotherapy might be of value in revealing further psycho- 
dynamics that are playing a role in his aggression." 

Q. Is there any indication in the record, in the materials that you have re- 
viewed that Fred received psychotherapy ? 

A. No, and that this experience in isolation is one which would not help him 
solve his hostility at all but which would perpetuate his being a verv hostile 
person. 

Q. Was a boy by the name of Anthony A. the third boy whom you examined at 
Goshen ? 
A. Yes. 

Q. In your opinion, is Anthony a boy in need of treatment? 

A. Yes. 

Q. What would that be? 

A. Anthony, too, has a great deal of difficulty relating to his peers, particulars 
in a non-violent way. He has a lot of difficulty in participating in a school situ- 
ation and in benefiting from it and a lot of difficulty establishing any kind of vo- 
cational niche for himself. 

Q. Plaintiffs' Exhibit 7-20 previously marked for identification and shared with 
Mr. Hoffman, which is the Goshen room confinement report for Anthony A 
dated February 10, 1974, indicates the following. I am reading a memo dated 
February 10th 

Mr. Hoffman. Your Honor, If I may, I move that these documents be placed in 
evidence, because counsel is reading from documents that are not in evidence 

Ms. Thorpe. I will be happy to introduce them into evidence, your Honor 

The Court. All right. 

Mr. Hoffman. So that we have them all in. All of the documents that have 
been referred to. 



83-303—77 14 



190 

The Court. All of the "7" series. 

Mr. Hoffman. The "7" series. 

Ms. Thorpe. All of the "7" series. 

The Court. All right. What are the numbers? 

Ms. Thorpe. 7-1 through. I believe. 7-24. is it? 

Mr. Hoffman. I meant the documents that the witness was referring to in his 
testimony. 

The Court. "Well, we might as well get them all in if they are going to go in at 
this point rather than separate the series. 7-1 to what? 

Ms. Thorpe. To 7-26, your Honor. 

The Court. All right. 

Is there any objection to this series? 

Mr. Hoffman. No. 

The Court. All right. Received. 

(Plaintiffs' Exhibits 7-1 to 7-26, inclusive, for identification were received in 
evidence. ) 

The Court. All right. Proceed. 

Q. The memo dated February 10, 1974, is a memo to the A. C, P. Boyce, refer- 
ring to Anthony A. 

"At four o'clock, wash-ups was called. This student refused to wash up, claim- 
ing that he washed up before 3-11 tour came on duty. Anthony was told that 
everyone on the wing has to wash up for evening meal. Student refused to wash 
up again and went to sit down in the TV area. He was then told to take it down 
to the end of the hallway and stand. He refused and said no one was going 
to make him stand. The HCS was called. Mr. Kozykowski came up to the wing 
and spoke to the student for about fifteen minutes. Mr. Kozykowski sent Anthony 
back to me to try and clear the incident up. I spoke to Anthony again, telling 
him that we as staff have a daily routine that we have to follow, and he, like 
all other students in the program, have to do what they are told and follow 
program rules and routines. Again Anthony refused to comply. Made threat 
about what he would do if someone tried to take him to Wing 1. 

"After refusing to walk down to Wing 1, after refusing to do everything else 
he was told, Anthony was completely negative and tried to use a chair when 
being removed from his room. Restraints applied on Wing 5 and reapplied in 
RC Room Number 1, and student given an injection when he failed to calm down." 

Now, the medical report following shows that the boy was given 50 milligrams 
of thorazine intramuscularly. 

Now. as a consequence, Anthony was held in isolation for a period of nineteen 
and three-quarter hours. 

As a result of your examination of the boy. did you make any findings as to 
the effect on Anthony of the isolation experience? 

A. Yes. Anthony was given an injection of thorazine, I believe, almost imme- 
diately upon entering isolation, so that his initial responses were colored by the 
thorazine, and he felt that he was unable to breathe and that he had no strength 
that he could not even get up, and he felt like he was going to die. 

When the thorazine wore off, he felt, like he was going to go crazy, and he 
also experienced some suicidal feelings, and he experienced a great deal of 
pessimism about the world. He felt that nobody really cared about anybody 
in the world at that point. 

I think, too. that again there was a reaction to the circumstances that led up 
to this, that because he did not wash his hands, a power struggle resulted which 
esi alated again into a very brutal struggle, and I believe that I read in his record 
that at one point it took six people to ultimately restrain him. 

So that a fight over washing his hands led to needing six people to quiet 
him down physically. 

Q. What consequences would that experience have for his treatment and 
rehabilitation? 

A. I think it increases his anger. I think it increases his distance from the 
helping people in the institution. I think it tends to make him — that when it 
works, when it quiets down, it makes him passive and compliant, but again 
only immediately, and that it builds up a long-term hostility to any attempts 
to help him. 

Q. Did you find in Anthony's case file any treatment plan which had been 
formulated for him which incorporated a plan for the use of isolation? 

A. No. 



191 

Q. Did you find any treatment plan at all? 

A. 1 really — There were his psychiatric evaluations and a psychological evalua- 
tion in his record. One psychiatric evaluation recommended that Stelazine, which 
is a thorazine-like medicine, be discontinued during the day. 

Another evaluation on the basis of psychological tests suggested that he might 
have epilepsy, which is a diagnosis that you really can't make on psychological 
tests. And they did demonstrate that he had a great need for affection. But 
there really was no synthesized treatment plan at all, and there was essentially 
nothing in the way of a treatment plan recommendation. 

Q. Doctor, in the course of your career, have you had occasion to observe and 
examine other people who were subjected to isolation while in institutions? 

A. Yes. 

Q. How many such people would you say you have examined and observed? 

A. Well, I have observed hundreds of such people, and I have examined quite 
a few. 

Q. On the basis of your training and experience with people who have been 
subjected to isolation, do you have an opinion as to whether isolation has an ef- 
fect on persons on whom it is imposed in institutions? 

A. Well, I found that in the majority of cases that it really increased their 
hi utility to the institution and alienated them from any attempts to help the 
institution. 

There are other kinds of effects from isolation, too. Isolation is a form of 
sensury deprivation, and I realize that it is a very relative form as it is in the 
institution, but relative forms of sensory deprivation can be very damaging to 
people. There is a syndrome of sensory deprivation which can occur when some- 
body goes on a long train ride by themselves, for instance. 

So that the kind of sensory deprivation that exists in the isolation cell is 
certainly more intense than what somebody would experience upon a long train 
ride. 

And in some of the individuals that I have examined in other institutions 
there has been a really, really serious psychological disturbance, which has 
to be described as a sensory deprivation kind of experience, in which these peo- 
ple became disoriented, confused, hallucinated, suicidal and even upon leaving 
the isolation cell, some of these changes continued. 

Actually, people have measured brain waves on people in these — this kind of 
experience, and they show brain wave changes which can persist for several 
hours after somebody leaves such a cell. 

Q. Have you ever observed the use of isolation, in and of itself, to constitute 
effective treatment? 

A. Never in and of itself. 

Q. In your opinion, could it? 

A. Not in and of itself, no. 

Q. Have you ever observed the use of isolation to have a successful effect 
from the point of view of furthering a person's treatment or rehabilitation? 

A. Only with overtly psychotic patients, and there only temporarily. But in 
the long run it — with the kind of individuals that I saw at Goshen, it would 
never further their treatment. 

Q. Doctor, I am going to read to you from Plaintiffs' Exhibit 2-1G pertaining 
to a boy by the name of Alvin Morrison. Now, this is not a boy that you have 
examined, is it? 

A. No. 

Q. This is dated July 24, 1973. Memo to A.C. from Mr. Sweeney. 

"Subject was verbally reported this a.m. for poor work habits. He has a 
lackadaisical attitude that he can do as he wishes. I counseled Alvin on de- 
tail about his worked habits and frequent breaks and that if they did not im- 
prove I would remove him from off-campus privileges. 

"He replied, 'I'm no jet. I'll work the way I want to work. Mr. Bertholf can 
do it better. Let him come down here and do it.' 

"Subject continued poor work habits, sitting on several occasions. At 10:20 
a.m., he said, 'I'm all through. I quit for the morning. I'm not killing myself 
around here any more. Why don't you do it?' I told him to get his clothes and 
that we were going to Wing 1. He replied, 'I'm not going to Wing 1. You can 
tell that to Mr. Bertholf. He'll have to take me there.' 

•'He was working in his personal shoes. I also noticed he had a new pair of 
work pants, which probably belonged to a new admission. Verbal to Mr. Bert- 



192 

holf, who also removed him from area. He has an arrogant, belligerent attitude 
when spoken to. Recommend removal from off-campus list and return through 
me." 

There is a note in another handwriting : 

"I talked to Morrison, placed in detension, and I agree with removal of off- 
campus and have it returned via Mr. Sweeney." 

Now, Exhibit 3-8 shows that this boy was in isolation for ten hours and 
forty-five minutes on that day. 

In your opinion, would putting a boy alone in a room for that period of time 
have the effect of helping him to develop good work habits ? 
A. I doubt it. 

Q. Do you think that isolating him under those circumstances — or what effect 
do you think that isolating him under those circumstances would have for his 
treatment or rehabilitation? 

A. Well. I think, once again, it increases his hostility to work. I think if he 
does go back to work, he would probably go back in such a way as not to really 
try to benefit from the work or really get into the work but rather to see if 
he can pull the wool over the authorities' eyes about, you know, getting away 
with as little as possible. 

You know, it builds in a kind of system that says, "You don't really have 
to work as long as you don't get caught at it," and it makes them again angry 
and more hostile to the institution and what the institution is trying to do 
for him. 

Q. Assume after the child is placed in isolation for an act he committed the 
day before; what conclusion if any would he be likely to draw from that? 

A. Well, that is always very confusing. I mean, if any punishment is to be 
applied and is to have any effectiveness, it really has to come as close to the 
act for which he is punished as possible. 

I would consider one day too much of a delay in that kind of a situation. 
Q. Doctor, assume that a boy has a physical fight with a peer and has been 
restrained by staff from further combat. Would it be beneficial or harmful 
to the boy to place him in isolation at that point? 

A. I think that would be harmful. I think the ideal way to deal with that 
is to get him away from the fight, to have him talk to somebody that he trusts 
and to make some attempt to undersand why he is fighing. 

Q. Doctor, I show you Plaintiffs' Exhibit 5-4, which are photographs of 
physical restraints. Have you seen any of these items before? 

A. Yes. I saw the plastic restraints, and I saw the handcuffs at Goshen. I 
actually had them put the plastic cuffs on my hands, and I found them, you know. 
extremely uncomfortable. Although I didn't struggle to get them off, there 
was a mark on my hand for several hours afterwards. 

Q. In your opinion, would the use of these restraints be beneficial or harmful 
for boys? 

A. I think that particularly the plastic cuffs and the metal cuffs are par- 
ticularly harmful. I think that, one thing they — I mean, they only control one 
part of his body just his hands. I think that they are probably very — it is 
probably very frustrating to have that part of your body tied to something 
that hurts. Probably a lot of it — a lot of other — it would probably induce a lot 
of other flailing around of the body, and it is a very punitive kind of thing. 

I mean, it is very important with adolescents to try to teach them self con- 
trols and to help them control themselves, but when you use something like 
handcuffs, I think you really prevent your basic purpose. 

Handcuffs are really associated with, you know, being caught for a crime and 
being taken into a police station, and I think that there would be very, very 
negative connotations to the student to have handcuffs placed on him. I doubt 
very much if he would ever experience them as something helping him to gain 
control of himself. 

Q. Doctor, what is the principal use of thorazine in psychiatric practice? 
A. Its principal use is for psychotic patients. 

Q. Are there any other uses which you would say are professionally accept- 
able? 

A. Well, there are some other very technical uses that I don't think really 
concern us here. They are uses for nausea and vomiting and an entity called 
porphyria, which I don't think we have to go into. 

There is one other potential use of it that is not as well established as in the- 
treatment of psychotics, and that is in the treatment of neurotic anxiety. 



193 

Tt is a drug that I will use with people who have a history of addiction to 
other drugs, because it is not basically an addicting drug, so that I might use 
it to trv to quell the desire for addicting drugs. 

Q. Are there side effects that are known to be connected with the use of 
thorazine? 

A. Yes. 

Q. Would you please name some of them for us? 

A. Well, there are a multitude of side effects with thorazine. There are some 
which occur quite commonly and with reasonably low doses, you know, sort 
of go into them first. One is drowsiness, lethargy. Sometimes if that kind of 
effect is carried to its extreme, it can inhibit breathing. 

Another side effect which is reasonably common is skin reactions. You can 
get different kinds of welts, for instance, on your skin from it. 

Another set of reactions which are common are what we call the Parkinsonian- 
like effects, and these can occur with a single dose. These induce a kind of 
Parkinson\s disease in the individual which is generally temporary. That means 
that they walk with a shuffling, slow gait, that their face shows little 
expression. 

These Parkinsonian symptoms can sometimes be carried to an extreme, and 
we have things that we call an oculo-gyric crisis, in which the eyes roll all 
the way back in the head, and opisthotonos, in which the neck gets pulled all 
the way back, and people will stay in these kinds of states for hours unless 
they are given the specific antidote. 

Another reasonably common effect is what we call orthostatic hypotension, 
and that means that if an individual is lying down or sitting up and goes to a 
standing position, that he will get low blood pressure. There are other cardiac 
symptoms which can result. People can skip a heart beat ; they get changes 
in their electrocardiogram, and on one occasion I did see an individual whose 
heart actually stopped from one dose of thorazine. 

Q. Now. is there a difference in the effect of thorazine if it is taken orally 
as opposed to intramuscularly? 

A. Yes. 

Q. What is the difference? 

A. If it is taken intramuscularly, you get a peak blood level or a peak 
pharmacological level of the drug which is ten times higher than the peak 
that you get if the drug is taken orally. So, said side effects I am talking about, 
like oculo-gyric crisis et cetera, or low blood pressure, are ten times more likely 
to happen. 

Q. Defendants in this case have admitted in the pretrial order that it is 
their practice to obtain "PRN" orders for intramuscular injections of thorazine 
to be administered as punishment upon inmates at Goshen. 

In your opinion, is such a practice acceptable? 

A. No. 

Q. Why not? 

A. Well, thorazine is a very potent drug. It has a lot of very strong side effects. 
There are a lot of contraindications to giving thorazine. And so that I would 
never give thorazine to somebody over the telephone unless I had done a very, 
very thorough evaluation. I would want to know a lot of things about his pre- 
vious medical history. I would want to know a lot of things about whether he 
had thorazine or any similar drug like that before and what its effects were. 
I would want to know about his psychological state. I would want to know 
if he had had other drugs before. I would want to know a great deal about this 
individual as a person and his previous medical and psychiatric history. 

I really could not see making that kind of determination without a very 
extensive evaluation. 

Q. Who would give an authorization for administration of thorazine, either 
orally or intramuscularly? 

A. Well, the authorization should really be given by a psychiatrist. It could 
be given by a qualfiied physician, but only after a thorough examination of the 
individual. 

Q. Assume for the moment that a youngster is acting out in a violent manner 
at the time that he is admitted to an institution such as Goshen, and no doctor 
is present at the time. Would current medical standards sanction the use of 
thorazine to calm the boy without a physician's authorization? 

A. No. Never. 



194 

Q. Is it standard medical practice to indicate in a patient's record why a 
PRN authorization for thorazine is being given? 

A. Yes. 

Q. Reviewing the psychiatric reports and medical cards of the three boys you 
examined at Goshen, did you find any such explanation for their PRN orders? 

A. No. Not for the intramuscular. 

Q. I am sorry. That is my question. 

A. Yes. 

Q. In those instances in which thorazine is appropriate, do you have an 
opinion as to whether it. should be given orally or by intramuscular injection? 

A. Well, it is always best to give thorazine orally. There are much less risks 
when you give thorazine orally than when you give it intramuscularly. 

Q. In your opinion, should a PRN order for the use of thorazine indicate that 
it should be given orally and only if refused by the patient given intramuscularly ? 

A. If the thorazine is being given as part of an ongoing treatment plan, that 
would be a way that a prescription might be written. Any PRX order that I 
have ever written for thorazine has been that it be given only if the patient 
refuses the drug orally. 

Q. What dosage of thorazine should be prescribed in a PRN order for an 
adolescent for the first time? 

A. Well, I am almost totally against PRN orders of thorazine. I think that 
they have to be a part of an integrated treatment plan. Thorazine has some im- 
mediate effects. It also has some very long-range effects, and I almost never give 
thorazine 

The Court. What are the long-range effects? 

The Witness. Well, when I was discussing the side effects of thorazine be- 
fore. I mentioned only the short-term ones, and I didn't mention any of the 
long-term ones. The long-term effects include that it can dampen the production 
of certain blood cells, so that you can have a lack of white cells or even a lack 
of red blood cells. It can cause some eye damage that it is permanent. It can 
cause an entity called tardive dyskinesia, which is a very painful kind of neuro- 
logical entity, which persists sometimes forever. It can cause hepatitis and 
cirrhosis of the liver. 

The hepatitis, by the way, is a kind of medium-range effect. You can get 
hepatitis after only two weeks on thorazine. 

In a decision to administer thorazine, particularly when given to long-term 
psychotics, it has some beneficial effects on a long-term basis. That is that it 
makes some changes in the body's basic metabolism that seem to help prevent an 
acute schizophrenic episode. So that if somebody, for instance, has had his 
schizophrenic episodes, I might give them oral thorazine for a year after their 
last schizophrenic episode. 

For this long-term effect as well as for its short-term anxiety -relieving effects, 
it is useful in that way. 

Q. Is there any relationship between body weight of a patient and the appro- 
priate dosage of thorazine? 

A. Yes. Some consideration of body weight should always be made, particu- 
larly when you are giving intramuscular thorazine. 

Q. Is it determinative of the dosage that should be prescribed? 

A. Yes. The two dosages that are used at Goshen are 25 milligrams and 50 
milligrams I.M., and all three of the individuals that I interviewed — well, two 
of them were given 50 and one of them was given 25. They were all really rather 
small. With all — I don't think any of them were over five-eight, and I doubt if 
any of them weighed over 150 pounds. So that they were all a little bit smaller 
than the average man. And, as I said, two of them who were actually a little bit 
bigger, but around 150 pounds, were given 50 milligrams i.m. of thorazine. 

Again, I don't think it should ever he given under these conditions, but even 
the dose of 50. I think a lot of authorities would consider too much. 

At St. Luke's hospital in New York City, it is the policy of the medical board 
to never give more than 25 milligrams of thorazine i.m. in any injection. So that 
you know even though I don't agree that there are any conditions to give it, if 
you are going to give it in somebody this size. I think you are running a greater 
risk by giving 50 milligrams than by giving 25. 

Q. What kind of review should lie made for the purpose of determining a re- 
newal of a PRN order of intramuscular injections of thorazine? 



195 

A. I think oue should really review a treatment plan very carefully and make 
a determination in the beginning at least every week to decide whether you 
should leave this order standing or not. 

If it was used on a regular basis, then it might not have to be reviewed quite 
as often. But I would really feel that there would have to be a very careful 
review, and it should not be just, you know, after one week PRN of thorazine 
renewed. There should be some statement as to why this order is being written 
and what purpose it will serve for the individual. 

Q. In reviewing the medical cards of the boys that you examined, did you find 
anv statement of why renewals were entered? 

A. No, not in the medical card, nor was there any in the record. 

Q. What kind of behavior or symptoms would a youngster at an institution 
like Goshen have to display to warrant renewal of such an order? 

A. I would really only say that such an order should be renewed for somebody 
who is actually paranoid, delusional and hallucinating and also out of control 
and also refusing oral medication. 

Q. Would you say that continued renewals would be appropriate if a youngster 
had not ever received a shot of thorazine under the l'RN orders? 

A. No ; they would not be appropriate under those circumstances. 

Q. Assuming that an injection of thorazine has been administered intramuscu- 
larly, are there any precautionary measures which should be taken afterwards? 

A. Yes. An individual who has an intramuscular injection of thorazine should 
be lying down for at least a half hour to an hour after that injection. In addi- 
tion, blood pressure readings should be taken before and at least every fifteen 
minutes for several hours. 

Q. I would like to go back to some of the incidents that you discussed earlier 
in your testimony. ^ _. •;**£ 

You recall that Exhibit 1-141B and 1-141C indicated that after Vincent P 
was placed in an isolation room he began yelling and screaming and banging 
and kicking on the door, and 4-40 indicated that he was given an intramuscular 
shot of thorazine, 

A. Yes. 

Q. In your opinion, would giving the boy a shot of thorazine be an appropriate 
response* to that reaction of his by current minimium standards of the medical 
profession ? 

A. No. Also, in his case, he happens to be an epileptic, and thorazine does what 
we say lower the seizure threshold. Therefore, it predisposes him to seizures. 

Q. So you are saying there is an increased risk of a seizures 

A. Right. . . 

Q. Do you think a boy should ever be given a shot of thorazine to quiet him 
down if he begins to act up after being placed in an isolation room? 

A. Not unless its cause is overtly psychotic and hallucinating, or paranoid. 

Q. Exhibit 1-14-A — or 141-A — excuse me — indicates that Vincent was not 
visited at all on August 26, 1973, after receiving the injection of thorazine. 
Would you say that it is consonant with current minimum standards of the 
medical' profession for a person has received such a shot not to be checked at all 
until the following day? 

A. I think that it is very dangerous. 

Q. Now, I call your attention again to the incident with Anthony A, which we 
discussed earlier, which is recorded in Plaintiffs' Exhibit 7-20. Was the intra- 
muscular injection of thorazine on that occasion consonant with current mini- 
mum standards of the medical profession? 

A. No. 

Q. Now. Plaintiffs' Exhibit 1-149-A reads as follows— this is dated September 4. 
1073, memo to the A.C. from Mr. Horan, pertaining to a boy by the name of 

David F. . . •':, 

"As directed bv A.C David was to be placed in detention this p.m. for failure 
to have his conduct memo signed by the 7-3 SCCW. This was explained in detail 
to the student by 3-11 HCCW, Mr. McLean. At the time he was to be brought to 
Wing 1. student became very nasty, hostile and refused to comply. It was neces- 
sary for Mr. McLean and myself to go to student's room. He finally came to 
Wing 1, but when placed in room refused to remove clothing. 

"All attempts to calm student failed. He became highly agitated, started 
making remarks he was going to hurt someone, said he could not stay in the 
room. 



196 

"Concern was shown, as student has a history of epilepsy, and he was on the 
verge of losing all control. Medication was administered by medical at 5 :40 
p.m." 

Now, in your opinion, was it consonant with current minimum standards of 
the medical profession to give this boy an injection of thorazine? 

A. No. I think that it is very dangerous to. I think that you really run a very 
high risk of producing a seizure in that kind of a situation. 

Q. Do you have an opinion about the actions on the part of the staff of forcing 
him into a room which, according to the memo here, caused him to become visibly 
upset? 

A. Well, I think that that also is the kind of stress that could provoke a 
seizure. 

Q. What would have been the appropriate action on the part of the staff to 
have taken in that instance, in your opinion? 

A. Well, I think that there should be a person that has a trusting relationship 
with this individual and that the student should be isolated from the rest of the 
students and placed in a room with somebody that he trusts and can communicate 
with, so that you know an attempt can be made to find out why he is so disturbed. 

Q. Doctor, Plaintiffs' Exhibit 4-3, which is the medical card for a boy by the 
name of Renia, indicates that the boy, either upon admission or almost imme- 
diatelv after admission, turned out to have hepatitis. 

A. Yes. 

Q. Now, this card also indicates that prior to having received notice of a 
normal liver function test, this boy was given an injection of thorazine. 

In your opinion, would that be consonant with current minimum standards of 
the medical profession? 

A. That would be very, very risky, and although it is not absolutely contra- 
indicated to give thorazine to somebody with liver disease, it is something that 
should only be done with the greatest of care and with a very, very thorough 
medical evaluation. 

Ms. Thorpe. Thank you. I have no further questions. 

The Court. All right. At this time, we will take a recess in this case. 
[Recess.] 

The Court. All right, you may commence cross-examination, Mr. Hoffman. 

CROSS-EXAMINATION BY MR. HOFFMAN 

Q. Dr. Kaufman, are you familiar with the work of Dr. Johnathan Cole? 

A. Yes. 

Q. Is Dr. Cole recognized as an expert in the use of medication? 

A. Yes. 

Q. Doctor, if I told you that yesterday Dr. Cole testified that there was no 
significant correlation between the weight of the boy and the amount of dosage 
or thorazine in terms of the effects, would you agree or disagree with his 
testimony? 

A. Well, we get into the word "significant." I would say that it is a general 
principle of pharmacology that the effectiveness of a given dose varies according 
to an individual's body weight. 

Q. So that you would disagree with Dr. Cole's testimony? 

A. I would — you see, there are some medicines that you give specifically ac- 
cording to pound of body weight. Thorazine is not one that you have to take 
body weight that much into consideration. 

But clinically we always take a person's size into consideration when we talk 
about dosage of thorazine. So I would have to disagree with him the way you 
stated it. 

Q. You testified about the long range effects of thorazine in terms of possible 
damage to the individual. 

A. Right. 

Q. What amount of dosage and what frequency of dosage would be needed to 
produce those effects? 

A. Well, the long-range effects, one really needs at least six months of thorazine 
for most of it. I also mentioned one like hepatitis, which is an intermediate range 
which you can get in two weeks. But for most of the long range we are talking 
about, six months, some of them like the eye changes, usually you don't get until 
about a year or so of constant use. 



197 

Q. Would that be on a daily basis for six months? 

A. Yes. 

Q. What dosages would we be talking about? 

A There we are talking about a minimum of— well, you could get it with 50 

milligrams a day but we are really talking about mainly about 100 milligrams a 

Q*. Have you ever known a violent, agitated patient to accept oral medication? 

A. Yes. 

Q. Without any coercion? 

A. Yes. 

Q. Will you describe how you have been able to get a violent patient to accept 

oral medication? „ „ . , L . , 

A. I would say that, you know, by trying to talk to him and trying to under- 
stand where he is coming from, you know, just what it is that's going on with 
him that, you know, frequently, or most of the time you can avoid having to give 
an injection. . H 

You know, it also will depend on what your definition of violent is. 

Q. Assaultive, for the moment 

A. Assaultive at a given moment. Well, if somebody is assaultive at a given 
moment, oral medication probably would not be that effective in dealing with the 
assaultive behavior. 

Q. You testified that you did not approve of the use of thorazine the way it 
was being administered at the institution. 

A. Right. „*..*, 

Q. And you also testified that you did not approve of the use of physical re- 
strainers and you also testified that you did not approve of the use of isolation 
rooms. 

A. Right. , . 

Q. What method would you prescribe for controlling a violent 16-year old boy 
who is attempting to assault staff or other children? 

A. Well, one of the boys described to me how at a point when he was on the 
verge of going out of control, or had just gone out of control, Mr. Mullen came 
down and spoke to him. He said that he immediately quieted down. 

And so what I am advocating once again is somebody who has a good thera- 
peutic relationship with the individual and a good therapeutic attitude to attempt 
to handle the situation on the spot. 

Q. Let's assume that the boy doesn't wish to speak to that person and instead 
tries to attack that person. 

What would you prescribe then? 

A. Again, I would really like to emphasize that I think that you can prevent 
a situation from escalating into that with the proper attitude. I have been work- 
ing with varying levels of disturbed individuals for 15 years and I have never 
been attacked. 

I can recall one of my — one interchange with an individual who was violent, 
whom I knew well, whom I knew his reaction to thorazine well, who had re- 
fused thorazine, and I went to him with two individuals who were in attendance 
and when I entered the room with these two individuals beside me, the individual 
quieted down. 

So that what I did in that situation was that I had enough confidence and 
enough power with me that he knew that he could be controlled should he really 
go out of control physically. 

So that you know that you can handle a situation with prophylactic control 
without actually having to use physical controls. 

Q. I believe you mentioned before that when a person goes berserk or becomes 
extremely violent that it might take six people to hold him down, is that correct? 

A. What I mentioned was that one of the reports here describes requiring six 
people to hold down a boy that was going out of control. 

That wasn't someone who was at that point flailing about in a psychotic way. 
You know, it was someone who was involved in a physical struggle and it took six 
people to win the physical struggle. 

Q. Have you ever had the experience of being involved in a physical struggle 
where it took a number of people to hold someone down? 

A. Well, there have been experiences out of my control in the prison where this 
happened. 



198 

At Lewisburg Federal Penitentiary, the number of people that intervened when 
somebody — when they could not contain somebody was generally about ten or 
twelve. And on a couple of those occasions they stood back and let me handle 
it by myself and I was able to, without that kind of physical thing. 

Those instances that I saw in Lewisburg, where they didn't let me intervene 
and where they handled it violently were brutal incidents to me. 

Q. Doctor, assume that other experts in this case testified that rather than use 
seclusion rooms, that the schools should physically restrain boys who have become 
violent until they have calmed down. 

What is the effect on other boys of seeing one of their peers being physically 
restrained by four or five staff members? 

A. Well, I am not sure it is any different from seeing him dragged over to 
seclusion by four or five staff members. And it depends on how it is done, you 
know, and it depends on who does it. I mean if you are dragging somebody off 
to isolation or if you are holding somebody to restrain them, it can be equally 
brutal. And it depends on how it is done. 

Q. You testified that you interviewed three boys at the Goshen 

A. Yes. 

Q. Did these boys know who you were in the sense of your relationship with 
this lawsuit? 

A. I told them that I was a psychiatrist that was here with Legal Aid involved 
in a suit to change the conditions at Goshen. 

Q. And would you say that these three boys were very sick boys in common 
parlance, very disturbed? 

A. Not compared to people in a psychiatric hospital. I would say certainly 
compared to adolescents in general they were disturbed. 

Q. Do you know why Anthony A was committed to a training school? 

A. I have some idea, yes. 

Q. What was the reason? 

A. I believe, I am not exactly positive of this, that there was a murder involved. 

Q. Do you know how he committed the murder? 

A. I believe it was with a sharp instrument. 

My recollection is that it is correct that it was a machine, as I remember. 

Q. What did he do to the victim? 

A. Realty- 
Ms. Thorpe. Your Honor, I have to object to this. The witness has no personal 
knowledge of what the boy did to the victim. He has knowledge, I will admit, of 
what the records reflect for what he was committed but beyond that I would 
object to probing any further. 

The Court. Yes. Where are we going now, Mr. Hoffman? What has this got to 
do with the issues before the Court? 

Mr. Hoffman. Your Honor, Dr. Kaufman — 

The Court. You are suggesting that the man is seriously ill and ought to be 
in a mental institution. I don't think anybody disagrees with that. 

Is that the point you are trying to make? 

Mr. Hoffman. The point I am trying to make, your Honor, is that these boys 
were highly disturbed, yes. 

The Court. And they ought to be locked up for their own protection? Is that 
the point? 

Mr. Hoffman. No, that is not the point. 

The Court. Then what is the point? 

Mr. Hoffman. My question is, would these boys necessarily give you a truthful 
picture of what had taken place at the annex. 

A. Well, I really checked the picture against whatever was in the reports and 
I think that what I described here is essentially a truthful picture because I 
think almost everything that I said here today I validated with the reports 
which I read. 

Q. Would these boys tend to exaggerate their feelings about their experiences? 

A. T don't know. T have two major disturbing findings of suicidal thoughts 
and that of becoming more anxious and more disturbed, and they are such that I 
have observed them in other people who were put in isolation situations in which 
you know there wasn't the same kind of issue in terms of my dealing with these 
bovs. 

Q. Doctor, are there any current medical standards for training schools? 



199 

A. Well, the American Psychiatric Association Committee on, I believe it is 
the Committee on— I am not sure if it is the Committee on Prisons or the Com- 
mittee on Right to Treatment, has put out a set of standards for medical and 
psychiatric care. 

At the present time I am reviewing these standards in my position as com- 
mittee chairman of the District Branch Committee on Psychiatry to make some 
recommendations to the New York City Prison System. 

So there are a group of standards. I don't have them with me, and I really 
can't quote them. 

Q. Are these for penal institutions or for juvenile 

A. No, these are for penal institutions. 

Q. Adult penal institutions? 

A. Right. Yes. 

Q. Now let us assume that a patient experiences a sudden and explosive loss 
of control in your presence. Now how would you handle that situation? 

A. I would always try to understand what the loss of control was about and 
I would try to deal with it. I would try to deal with what is causing it. And I 
would try to communicate to him that I understood what he was feeling. 

Mr. Hoffman. I have no further questions. 

REDIRECT EXAMINATION BY MS. THORPE 

Q. Doctor, I have just one further question. 

Would a violent patient who is given a choice of oral medication or an injec- 
tion, a needle, be likely to accept the oral medication under those circumstances? 

A. I think very frequently he would and that's been my experience in a lot 
of eases. 

Ms. Thorpe. Thank you. 

The Court. All right, thank you, Doctor. 

You may step down. 

[Witness excused.] 

The Court. Is there another witness for the plaintiff? 

Mr. Guggenheim. At this time, your Honor, for the convenience of defendants, 
they are going to put on an expert witness. 

The Court. Do you have any more witnesses? 

Michael G. Kalogerakis, called as a witness by defendants, being first duly 
sworn, testified as follows : 

DIRECT EXAMINATION BY MR. HOFFMAN 

Q. Dr. Kalogerakis, what is your professional training? 

A. I am a psychiatrist in practice and a psychoanalyst. 

Q. Do you want the background on that? 

A. Yes. 

Q. I completed a residency in psychiatry at Bellevue Hospital in 1959. I have 
been attending on the staff of Bellevue Hospital since that time, attending 
psychiatrist. Since 1965 I have been exclusively aflBliated with the adolescent 
service at Bellevue. Until 1965 I was a junior attending psychiatrist, since 
1965, I have been the chief psychiatrist on the adolescent inpatient service. Are 
you a member of any boards and professional organizations? 

A. Yes, I am board certified with the American Board of Psychiatry and 
Neurology. I am licensed to practice medicine in the State of New York. I am a 
member of numerous organizations, a fellow of the American Psychiatric Asso- 
ciation, past president of the Society for Adolescent Psychiatry, present president 
of the Society of Medical Psychoanalysis and numerous other organizations I 
could name. 

Q. Have you written any articles or books on the treatment of adolescents? 

A. I have. 

Q. Would you name those? 

A. Yes, I have a book that was published this past year, Emotionally Troubled 
Adolescent and the Family Physician, which I edited. There are numerous arti- 
cles, Homicide in Adolescents, Fantasy and Deed, The Assaultive Psychiatric 
Patient, Therapy of Assaultive Psychiatric Patients, The Sources of Individual 
Violence. There are others. 

Q. Doctor, will you describe your present duties at Bellevue and the type of 
clinic that you run there? 



200 

A. Yes. I am assistant director of child and adolescent psychiatry and I 
have many administrative and teaching responsibilities in regard to that. My 
more specific day-to-day functioning is concerned directly with the inpatient 
adolescent service of which I am chief, and in that capacity I am both admin- 
istrator and chief clinician as well as teacher. 

Q. Will you describe the type of children that you work with at Bellevue? 

A. Yes. On adolescent service we take inpatients, boys and girls, aged 12 
through 16 inclusive, who are residents of Manhattan or Staten Island. We 
are the only inpatient adolescent service for Manhattan and Staten Island, and 
in a receiving hospital. And since our admission policy is to take any and all 
patients who require hospitalization, without any restriction whatsoever, pro- 
viding that they need hospitalization, we see the spectrum of psychopathology, 
you might say, with the emphasis, of course, being at the sicker end of the 
spectrum. 

Q. Is there a similarity between the children that you work with and the boys 
at the Goshen annex? 

A. I would say that we ■ 

Ms. Thoepe. Objection, your Honor. There has been no foundation that this 
witness knows anything about the boys at the Goshen annex. 

The Court. Well, what do you say, Mr. Hoffman? 

Have you visited the Goshen annex? Do you know what 

The Witness. I have, your Honor. 

The Court. All right. Proceed. 

A. I am familiar with the type of adolescent at the Goshen annex from, of 
course, many years of having dealt with patients that have either been at the 
annex previously or that we have sent on to the State Training School and have 
ultimately ended up at Goshen. I am as familiar from having visited there not 
very long ago. And I would say that one portion of the type of the patients that 
we have at Bellevue are the kind that I see, that I am aware of being institution- 
alized at Goshen, and that portion is the most violent, most disturbed end of 
the spectrum, perhaps barring those who are frankly psychotic who ordinarily 
end up in the state hospital system. 

The Court. Well, are there psychotic boys at Goshen? 

The Witness. I can't truthfully answer that, your Honor. What I know, I was 
interested in the question myself and when I went there I asked that of the 
assistant director and what he told me was that there are quite a number of 
patients there who he felt belonged in a psychiatric hospital rather than there, 
but the psychiatric hospitals today have such a restricted — the children's hos- 
pitals are all open settings, none of which have any locks on the doors, they have 
no real opportunity for restraining a child even from running away in many 
cases. 

The Court. In a mental hospital? 

The Witness. That's right. 

For example. Manhattan Children's Center. 

The Court. Why is that? 

The Witness. Well, I believe it's a — my own opinion, your Honor, is that 
there was an error in the — at the policy-making level some years ago when the 
state children's hospitals were set up, and I think the planners had in mind a 
relatively docile, cooperative patient as representative of the entire patient pop- 
ulation, which happens not to be the case. So that they set up the children? 
hospitals, in contrast to the adult hospitals, as totally open settings without a 
locked unit of any land. And I recall, on visiting Rockland Children's Psychiatric 
Center at the time that they were moving the patients over from the adult 
division. Dr. Mashikyan — I noticed people busily running around and doin.i 
things. I said, "What's going on?" He said, "Oh, they are busily putting locks 
on elevators and doors because we have no locks and we are finding that we are 
running into all kinds of trouble already with the kids who are unmanageable 
in a totally open setting." 

In any case, at Manhattan Children's Center I cannot send patients from 
Bellevue to Manhattan Children's Center if they pose any minimal problems in 
behavior, such as running away. 

What Dr. Loche tells me regularly, and she is the director, is that any kid can 
walk out at any time, cross the walk-over bridge into Harlem and mug somebody 
on the street and perhaps come back when he is good and ready or else be picked 
up. She has absolutely no control over that. 



201 

So we run into very difficult situations of placement and I think the matter 
is nowhere more serious than when we are talking about the violent patient who 
has been very much short-changed in our system. 

The Court. Well, going back to the original question, you don't know of your 
own knowledge then whether there are any boys at Goshen who are psychotic ; 
you are relying on something a director told you? 

The Witness. I do not. He did not — the question was not specific to the presence 
of psychosis in the kids there or not, so that I really have no information on that. 

The Court. All right. 

By Mr. Hoffman : 

Q. Doctor, do you have to deal with violent adolescent behavior in your ward? 

A. I do. 

< „>. Would you describe the types of violent behavior that you have to deal with? 

A. Well, I think that basically it tends to fall into two major categories. One 
is what we might call group violence, collective violence, and generally involves 
either a small group or even a larger group of patients acting up together, and in 
the more serious instances, of course, posing a real threat of riot. Thai comes up 
very, very infrequently. The small group, let's say two or three kids banding 
together and possibly either picking on another child or making trouble for 
staff, generally that is a lot more common. 

The other type of violence, which is a lot more common, is individual violence, 
which takes many forms. It might be a slowly — a slow crescendo building up to a 
point of explosion, or it may be very precipitous and totally unpredictable. And 
of course that is it, that last variety is the kind that poses the most serious 
problems for staff because it doesn't give us the opportunity of sitting down and 
talking with the kid or pulling him aside and trying to work on him, work with 
him on his anger, which if we can do of course very often will resolve the problem, 
not always. 

Q. What are the options available and the solutions to dealing with these dif- 
ferent types of violent behavior? 

A. Well, I would think that one always begins with the least restrictive alterna- 
tive, and the most humane alternative perhaps, and for all of us I believe that 
is to talk with the patient, or talk with the group of patients, as the case may be. 
That presupposes that we have some warning, some information, knowledge that 
trouble is brewing. And we often do ; we sometimes don't. 

In the case of some of the more disturbed youngsters, if we are talking, for 
example, about an organically brain-damaged child, this can be so totally out of 
the blue that there isn't any way of knowing, and what he may do is just be 
walking very peacefully down the corridor and he will suddenly lash out at a 
much younger child who isn't expecting anything and do serious damage. That's 
quite uncommon, I would say, but we do get that. And more commonly we will 
get a patient who is psychotic, usually schizophrenic, and who may be respond- 
ing to a voice, and the ability to predict it is a bit better but not necessarily very 
good. There, too, we have to be prepared at a moment's notice to intervene'. Such 
patients are usually medicated with antipsychotic medication, tranquilizers, and 
that may or may not 

The Court. Is that thorazine or something different? 

The Witness. Thorazine is one of the — is the most commonly used tranquilizer 
for psychotic patients, your Honor. 

The Court. Well, again you are talking about patients that are psvchotic, is 
that it? 

The Witness. Yes, at the moment. Yes. 

The Court. All right. 
By Mr. Hoffman : 

Q. Continue, doctor, please. 

A. So that as I said that, the medication, may or may not control the psychotic 
outburst that may occur. Sometimes even with fairly heavy doses we will get 

an outburst and we do have to be prepared to contend with that. The other 

assuming that there is no forewarning and we are reallv dealing with a sudden 
crisis that we are confronted with, the first thing would be to restrain the 
patient to make certain that no one else gets hurt. The next decision which has 
to be made very rapidly upon that is what the possibilities are of getting the 
patient to be reasonable: Is he listening? Is he able to listen? Is he totally out 
of control? Is he perhaps out of touch with reality? If he is not, then we may 
be very successful in just pulling him aside, calming him down 



202 

Very often he has been provoked by another patient and if we can get him 
away from the other kids that will frequently be all that's necessary. So this 
would be kind of the next step. In the event that this doesn't work we have a 
number of other options. In some instances taking a patient into the office and 
sitting down with him and talking with him will be all that's necessary. In 
others, offering him or giving him some of the medication that he is already on 
but an additional dose orally, if he can accept that and is able to swallow it, let's 
say, will be sufficient. In other instances that is quite out of the question and we 
may use medication intramuscularly, and even intravenously in the rare occa- 
sions where a patient is totally out of control and perhaps very, very dangerous 
because of his size and power. 

Seclusion is one of the methods that 

The Court. Are we still talking about psychotic people? 

The Witness. No, your Honor. I have — I described the psychotic as one of 
those who may be unpredictable. Now, we have many patients who are not at 
all psychotic, who may be severely emotionally disturbed but who would not be 
in the psychotic category. These are patients who may have very strong anti- 
social impulses, many are very aggressive, many are filled with tremendous feel- 
ings of anger and rage, hostility perhaps, and these are patients who may or may 
not be able to maintain control over their impulses. 

Now, these patients too have to be restrained from either hurting themselves 
or hurting other patients or staff. 

The Court. All right. Well, I just want to understand what you are talking 
about, whether you are talking about the treatment of psychotic people or the 
treatment of people who are not psychotic. You are now telling us about non- 
psychotic people being confined, is that it? 

The Witness. That's right, your Honor. 

The Court. All right. 
By Mr. Hoffman : 

Q. Will you discuss the use of seclusion with severely disturbed adolescents? 

A. I think that my own feelings about seclusion are that it is part of the 
psychiatric armamentarium for managing the severely disturbed patient, regard- 
less of the diagnosis, and that used judiciously it is a most important part of the 
armamentarium. Judiciously means that there is a specific psychiatric indication 
and that there is sufficient supervisory control so that it is not abused, as we 
know very well it has been from time immemorial. 

At Bellevue we may have occasion to use seclusion quite infrequently. In re- 
viewing with our head nurse the actual extent to which we use it might amount 
to no more than 20 to 30 hours, total patient hours in seclusion, over the course 
of a month. 

So you see it doesn't add up to very, very much at all. However, it is a most 
essential part of our armamentarium. Very often the patient himself is telling 
us, either verbally or very clearly in a nonverbal way : Get me away from these 
kids, I can't stand them, I want to be alone, put me in seclusion," let me cool 
my heels for a while, I will be fine in a half hour, in an hour, or something of 
this sort. 

We never keep anyone in seclusion for more than two hours without releasing 
him, and very, very rarely do we have to extend it beyond that. When we do, it 
is perhaps to six or eight hours, and that occurs maybe twice in six months. So 
that is very uncommon. 

Besides the patient asking us for seclusion we may make a determination 
based on the fact that we know the particular patient's needs to have extern.il 
controls applied when he, his own internal controls are failing, which is what 
violence is really all about. Very often violence is merely an expression of help- 
less rage and the violent patient is frequently asking others around him to 
please stop him, to please restrain him. and seclusion I think is very often 
one of the more humane ways of doing that. 

Obviously, sometimes a patient can be held down if it looks as though it is a — 
the kind of thing that can blow over in a couple of minutes, which sometimes 
is the case. Then just holding the patient may be enough. But that isn't alwa 3 
the case. And some patients go info a rage and it takes a good ten or fifteen 
minutes before— and longer— before they will calm down. They may calm down 
and still be dangerous. 

So that in itself, an explosion in itself is not the only consideration. 



203 

I am sorry, but I lost the original question, Mr. Hoffman. You asked about 
the use of seclusion. 

Q. Yes, on the violent adolescents. 

A. Invariably the way we use it is that if a kid tells us, "I am ready to come 
out now," he comes out. It could be five minutes later. We check on him regu- 
larly to make sure that he is fine, and I think one of the things that we always 
are concerned about is that the violent patient is sometimes as suicidal as he 
is homicidal. And so 

The Court. When were you at Goshen? 

The Witness. Some time last fall, your Honor. 

The Court. Did you find the situation different there from what you have 
just described with respect to seclusion? 

The Witness. Yes, your Honor, I did. I think the fact that seclusion was used 
for a much more extended period of time was a very distinct difference from 
the way we use it and I made that point to the staff at that time. 

Q. You were again continuing your description of the use of seclusion in 
suicidal behavior? 

A. Yes, I think that' one of the important concerns. Sometimes — this hap- 
pened in the course of the past week — a patient is placed in seclusion and he 
is — it's a patient that is known to us, we knew exactly what his style reaction 
is and so on, and it didn't help him because he continued to remain angry, he 
was kicking at the door and so on. We let him out within five minutes after 
putting him in and he was then able to calm down. But the very act of letting 
him know that we will intercede if he is losing control, we will help to reestab- 
lish his own controls, this is the therapeutic purpose of the use of seclusion 
as it is with other things. And this is what we tried. 

Q. What are the contraindications of physically restraining a teen-aged boy ? 

A. Well, it's a highly variable thing and here again it varies from one patient 
to another. For some patients that I have seen — and they are not by any means 
rare — probably because of the tremendous amount of physical abuse that they 
have received in their own homes they are exquisitely sensitive to any kind 
of physical contact that takes the form of restraint and they will react to that 
by becoming even more agitated rather than being calmed by it. So I certainly 
would not think that physically holding a patient or subduing him would work. 
Although perhaps indicated with some kids, it would certainly not work with all 
kids. 

Some very specific dynamics arise with the more paranoid patient and I am 
not talking necessarily of the psychotically paranoid patient; I am talking 
about the paranoid patient who may be severely emotionally disturbed, well 
short of psychosis, and that is that a — such a paranoid patient may experience 
any kind of physical holding as a homosexual assault, and this can, since this 
is often the basis for a lot of violent outbreaks and those who have studied 
the whole phenomenon of homicide know that very often homicide results, oc- 
cur during a paranoid, severe, acute paranoid disturbance in that individual who 
has strong aggressive tendencies. Somebody looks at him and he feels he has 
a yen for him and he will assault him and possibly kill him. We don't see that 
as commonly with adolescents as it is seen in adults but it is a dynamic which 
I have observed on numerous occasions and I think is something that a staff 
in an institution such as ours or Goshen needs to keep in mind in regards to 
physical restraint. 

Q. Is it always possible through a good treatment program to prevent children 
from becoming violent? 

A. I didn't hear the question. What's the question? 

Q. Is it always possible through a good treatment program to prevent a child 
from becoming violent? 

A. My answer to that would be that a good treatment program is a basis for 
any management of disturbed children and there should always be a good treat- 
ment program, and if not, a better treatment program. Whether, when you are 
dealing with the most disturbed population, you can prevent all violence or 
all violent outbreaks is quite another matter. I don't think you can simply be- 
cause it is the nature of the beast as it were. We don't cure patients by good 
treatment program. We help the patient, in the context that we are talking 
about, to maintain more control, to perhaps better his controls. But we cer- 
tainly do not provide him with newly found controls overnight or even over a 
long period of time, and it is a very lengthy process during the time of work- 



204 

ing with the patient towards the establishment of better controls, towards the 
reduction of aggressive impulses. 

Of course, you may get and will get many, many outbursts, depending on the 
patient. 

Q. Is there a category of boys that you have dealt with who express no feel- 
ings of anxiety or guilt or remorse about things that they have done? 

A. There is. And in truth we don't see too many of them at Bellevue because 
I think they probably — they go the route of the Family Court and are not likely 
to be the ones that the Family Court judge will think of remanding to us for 
psychiatric evaluation. They may more often go directly to juvenile center and 
thence to the New York City training school system. But I have seen a fair num- 
ber over the years of kids who are what in the traditional psychiatric nomencla- 
ture have been called psychopaths, are more commonly called sociopaths today. 
And these are often kids who at least functionally seem to have lost all care for 
any other human being. They may even have lost any concern for their own life 
and limb. They are kids who frequently tell us, for example, that — I like to ask the 
question, you know, "What do you assume your life would be like — what do you 
think your life would be like when you are 20?" and when I get the answer "I 
will be dead by then," as I have very often gotten, I know that I am dealing (a) 
with a depressed kid, but very often someone who has given up, that is depressed 
at a deeper level, but in terms of how he functions is someone who has given up 
on any faith in life, any belief in himself or any trust in any other human being, 
and if you have that combination together with a lot of rage and a lot of bitterness 
and the tendency to burst out in aggressive action, then of course you have a 
dangerous individual. 

Q. What are the methods that you would have to use to control the boy who 
has no feelings of guilt or remorse about attacking another human being? 

A. Well, reasoning with him is obviously not something likely to work, unless 
you can impress him with the fact that he stands to lose a great deal by not 
controlling himself. The kind of leverage we have there is very often such a boy or 
girl wants more than anything else to go home. Our pitch is, "You have to dem- 
onstrate to us that you are capable of returning home and making a go of it 
there. We want to send you home, that's our most fervent desire, but you have to 
make it — convince us that this is the reasonable course." That appeal may help. It 
very often does, I think. 

In some instances, perhaps with the angrier individual, it doesn't. Then we have 
to use the various methods that I have described. 

One additional method, which I didn't refer to, which we are able to use at 
Bellevue, which we use I don't think in as restricted a fashion as possible, is 
transfer of the patient off the ward. This will sometimes be necessary when that 
patient is serving as a catalyst for creating a riot situation. Sometimes it is in 
the — more clearly to protect the patient against a tremendous amount of aggres- 
sion from others which may take a sexual form, sexual abuse, or it may take a 
very directly aggressive form. Until we can straighten out the situation with the 
patients. So that is another use. 

Sometimes kids will say, "I can't stand to be with kids my own age, I want 
to be with adults." And that works out pretty well in that case as well. 

Q. Is seclusion ever used for the purpose of establishing limits on violent 
behavior? 

A. Oh, yes. I would say so. I think it — as I have been saying, I think the major 
purpose, therapeutic purpose, of seclusion is to help the individual patients to 
reestablish controls over his destructive impulses which he himself wants to re- 
establish, and that in that regard of course we are placing limits on his further 
violent activity. 

Q. Doctor, do you believe that it is either destructive or cruel to place a boy 
in confinement if he is a danger to himself or danger to other children? 

A. This is a question that always comes up and I think that there are many 
things that we use as part of our psychiatric armamentarium. There are many 
things that parents do with their own children at home that, if used properly and 
used compassionately, are essential methods of either child rearing or psychiatric 
treatment. 

Obviously when they are abused, as any one of these things can be abused in 
the hands of a sadist, in the hands of someone who is indiscriminately— uses no 
judgment, let's say, about what he does, this can be a most destructive practice. 
I think that although many would believe — I think what we don't know really 
is just how destructive even the abuse can be. I think that we can speculate a 



205 

great deal about it, but there really is very little, if auy, bard data in terms of 
followup of such things to be able to permit auy oue of us to state categorically 
that even when abused, that there is really severe damage to the growing person- 
ality. I think that when it is not abused I would not anticipate any damage 
whatsoever, and that's the important thing. 

Q. What is the result when seclusion is eliminated from an institution? 

A. I will come back to what I was referring to earlier in response to Judge 
Motley's question, and that is that the — one of the rulings that has caused a 
tremendous problem for us at Bellevue that has come down from the Department 
nf Mental Hygiene only perhaps two or three years ago was the complete elimina- 
tion of the use of seclusion in the children's hospitals. 

The Court. Do you know why it was eliminated? 

The Witness. Well, I think, your Honor, for the reason I gave earlier, namely, 
that I think there was some policy, at a high policy level, some feeling that it 
is automatically destructive and sadistic and cruel, and that has certainly not 
been my experience, and what it has led to is that the child that they are seeking 
•i otect in fact ends up getting hurt, because rather than going to a children's 
hospital, where he should go to get the treatment that he needs. I have the refer 
him back to the Family Court judge, the Family Court judge says, "Doctor, what 
am I supposed to do with this kid? You teil me lie is emotionally disturbed and 
ought to be in the hospital. I cannot remand him to a — to the Department of 
Mental Hygiene. What am I supposed to do with him?" And of course I have no 
answer. 

Actually at the moment there is a bill before the governor that you may be 
aware of which will permit the Family Court justices to place a patient directly 
with the commissioner of mental hygiene and he will have to find a placement 
for thein. 

Now. that will help, but right now these kids that formerly used to go to the 

st;ire hospitals are not going to the state hospitals, are being returned to the 

•t. may end up being in short order committing homicide, and I have a very 

recent case in mind, it only came to my attention last week, of a former patient 

of ours, and of course no treatment of any sort is being provided. 

The Court. Well, I think you lost the original question. The original question 
was why the Mental Hygiene Board adopted — or, rather, eliminated the policy 
of seclusion. Did they have some reason for it? Is that the result of some study or 
something? 

The Witness. I know of no study, your Honor, that would justify such a broad, 
sweeping action as that. In terms of the specific reason involved I can only 
speculate as I have but I do not know. 

The Court. All right. 
By Mr. Hoffman : 

Q. Doctor, what is the difference between seclusion, or room confinement, at 
an adolescent institution and solitary confinement at an adult prison? 

A. I can't speak from the standpoint of a — 

Ms. Thorpe. Your Honor, I have to object again. There has been no founda- 
tion laid that the witness has any knowledge at all of adult prisons. 

The Court. Do you have any knowledge of adult prisons? 

The Witness. No direct knowledge, your Honor, no. 

The Court. All right. 

We are going to recess now until 2 o'clock for lunch. 

[Luncheon recess taken.] 

afternoon session 

Michael G. Kalogerakis resumed. 
[Jury present.] 

DIRECT EXAMINATION CONTINUED BY MB. HOFFMAN 

Q. Dr. Kalogerakis, how many children are remanded to you by the Family 
Court? 

A. Well, over the years it's been between 40 and 60 per cent of our patient 
population. And we have had — at the present time our usual ward census is 
about 25 but in the past we have run as high as 40 and more. 

Q. Are some of these children sent back from your institution to the Family 
Court ? 

A. Yes. The majority, the vast majority. 

83-303—77 15 



206 

Q. Do some of these children go to training schools thereafter? 

A. They do. 

Q. Do you have occasion at time to recommend that a child be placed in a 

training school? 

A. Yes. Not infrequently. 

Q. What are the reasons for making such recommendations ? 

A. Well, generally speaking, we will make that recommendation when we feel 
that what the particular adolescent needs more anything else is external — the 
provision of external controls in the face of his inability to exercise internal con- 
trols which keeps getting him into trouble. 

Q. Approximately what is the amount of your population, that is, psychotic, 
and the amount of your population that is not psychotic? 

A. Well, the truly psychotic patients are a minority. Seldom more than 33 per 
cent of the ward at any given time. 

The Court. Seldom more than a third? 

The Witness. That's right. 

Q. Do you find that the use of seculsion at your institution varies with one 
group or another? 

A. I am sorry. Would you repeat that? 

Q. Do you find that the use of seclusion at your institution varies with one 
group or another? By "group" I mean the psychotic and the nonpsychotic 
children. 

A. Yes, I think we are more likely to use seclusion with the nonpsychotic pa- 
tient. The nonpsychotic patient is the one who is having — who has the capacity 
for exercising internal controls over his behavior, but who loses that periodically 
and who is therefore helped by a temporary — by temporary placement in seclu- 
sion so that he can reconstitute, as it were, his own ego resources. 

With the psychotic patient that is not likely to happen, or does happen some- 
times, but it perhaps is less likely because of the fact that his ego controls tend 
to be much more chronically poor and do not respond as well to the — this kind of 
provision of external controls. 

Q. Now, based upon the fact that a number of the boys that you have treated 
have been placed in state training schools, would you express your opinion on 
the necessity of seclusion or confinement to state training schools? 

A. My opinion is that it should be used as little as possible, that it should 
be available for the occasional instances when it is going to help the patient to 
reestablish those controls which are so essential to his own feeling, to his feel- 
ing happy with himself, and also essential to his reestablishing his ability to 
function with his peers and generally. 

Q. Doctor, do you use thorazine at Bellevue? 

A. Yes, we do. 

Q. Do you use thorazine in what might be described as a crisis intervention 

situation? 

A. We can and do. More likely than not it would be with a patient who has 
been receiving thorazine as part of his overall management and treatment, and 
so that we know what has particular response to the medication is and how 
effective it is. This helps in selecting the proper medication. 

After all, there are other medications available besides the phenothiazines and 
we use them as well. 

Q. Do you use thorazine to control highly agitated children? 

A. Agitation is one of the specific psychiatric indications for the use of thora- 
zine, yes. 

Q. What are the indications and contraindications of using thorazine in that 
case? 

A. In the case of agitation? 

Q. "Xes, a highly agitated child who is becoming assaultive. 

A. There are no contraindications. As long as the basic precautions that are 
essential in administering medication of any kind have been taken. 

Q. Has it been your experience that a child who is given medication under 
those circumstances would experience any dangerous side effects, any per- 
manently harmful side effects? 

A. Thorazine is not one of the dangerous drugs. The side effects that we see 
from thorazine are when a certain level of thorazine in the blood is reached we 
get what is called the Parkinson effect, which can be easily averted by admin- 
istering at the same time that you administer thorazine one of the anticon- 
vulsants, and these are well known and used quite regularly. 



207 

I am sorry. That is not correct, not anticonvulstant but anti-Parkinsonian, 
such as Artane, for example. 

Now, the side effects that we know besides that are rarely an occasional hy- 
potensive response in which the blood pressure drops and the patient may feel 
very, very faint, and this is usually adequately managed by placing the patient 
in bed or in a prone position. Sometimes it requires the administration of addi- 
tional medication to raise the blood pressure. But that is very, very rare. 

Another side effect of thorazine, which is an undesirable one but by no means 
dangerous, is jaundice, and I think what needs to be pointed out there is that 
the jaundice is not jaundice which results from actual damage to liver tissue, 
what we would call parenchymatous jaundice. It is obstructive jaundice which 
simply involves the occlusion or the blocking of the canals that deliver the bile 
from the liver to the intestines. There is no real danger in that. And, as a mat- 
ter of fact, patients with hepatitis can be given thorazine with impunity, and 
patients who are chronic alcoholics and have, say, cirrhosis of the liver can be 
given thorazine with no damage to the liver as a consequence. 

Q. Is thorazine preferable to other medication in the control of the violent 
patient? 

The Court. Do you give thorazine to patients who are not psychotic? 

The Witness. Yes, we do, your Honor. 

The Court. What is the purpose of that? 

The Witness. Well, I mentioned earlier that one of the specific indications of 
the use of thorazine is agitation. Now, agitation may occur in a psychotic pa- 
tient, but it can very well occur in a nonpsychotic patient, and it is very, very 
definitely beneficially affected by the administration of the phenothiazines. The 
phenothiazines are not exclusively antipsychotic agents, they are used primarily 
in that way, but they are used also for marked agitation and severe anxiety. 

Q. Is thorazine preferable to other medication in the control of a violent 
patient? 

A. It may be, and here you really have to know your patient. I think there 
are many differences in, as with all medications, the — many variations between 
one patient and another. If you know your patient, if he has been receiving the 
particular medication you can predict much more intelligently what effect a par- 
ticular dose of medication, of a specific medication, will have. It's always best, 
of course, not to use a known medication with an unknown patient or with a 
patient in whom the effect is not known. And that's a basic medical precaution. 
There are instances where one of the — one of the reasons why we would prefer 
to use thorazine rather than, let's say, the most common alternative, which is 
barbiturates, is because the level of tolerance, the level of safety between the 
optimal effective dose and the point at which toxic effects, undesirable toxic 
effects, begin to occur is rather large, quite broad with thorazine. It is far less 
broad with other medications, notably the barbiturates. So that we would gen- 
erally prefer to use thorazine rather than barbiturates. 

In the case of a patient who is, however, completely out of control and some- 
one who is big and powerful, and particularly if we happen to have one male 
aide on duty and there are three femal aides trying to help this one male aide to 
subdue a patient who may be an expert in karate and could, you know, really do 
very serious damage if he really lets go, what we have to go to then is something 
that will work immediately and there the medication of choice will not be 
thorazine, it would be sodium amatol, one of the fast-acting barbiturates which, 
if given in the muscle, will quiet the patient within three to five minutes, let's 
say, if given in the vein, which is perfectly safe, will quiet the patient instantly. 
And sometimes it is really the only way to protect life and limb of other patients 
and staff, as well as the patient himself, of course. 

Q. Doctor, have you read the rules and regulations of the Division for Youth 
pertaining to room confinement? 

A. I have. 

Q. Would you express your opinion as to the propriety of using room confine- 
ment in accordance with those rules and regulations? 

A. Well, I differ with some of the rules, as you know. I had more to object to 
in the past than with the revised system. I think a lot has been changed and is 
much more palatable. To my particular approach I still have questions about 
the use of seclusion for as long as 24 hours, for example. I am not saying it can't 
be justified in certain cases as long as the patient is checked with regularity, pos- 
sibly removed for a few minutes every couple of hours. It may be justified, de- 



20& 

pending on the nature of the case. I wouldn't rule it out, but my preference would 
be for the use of exclusion as a — for acute situations of crisis intervention and 
not for more extended periods of what might be called treatment behavior 
modification. 

Q. Doctor, do you think that there is any uniform way that the institution 
could react to the explosions of individual children? 

A. Not really, because there are some variables. No. 1, what I was saying this 
morning in terms of the particular diagnostic category that the patient falls 
into I think I mentioned for example that with a population such as we have at 
Bellevue, but that perhaps you don't have a Goshen, the organic brain-damaged 
person who loses control is the most serious, poses the most serious danger of all. 

Now, that requires a much more immediate and definitive response than some- 
one whom you might be able to reason with a little bit or someone who will more 
easily be held down momentarily while medication is administered, a camisole 
will have to be used with the organic very often, and sometimes as a most effec- 
tive means of helping him to control himself. I don't believe that you can draw 
general rules. I think that good medicine is a highly individualized medicine. 

Good medicine is base on as firm a knowledge, as intimate a knowledge of your 
particular patient, as is possible. 

Q. Do you think that if there was a higher staff ratio at Goshen Annex, or at 
other institutions, that the use of seclusion could be eliminated completely? 

A. No, I don't think it could be eliminated completely. I think it could be 
minimized. But I would be in favor of a better staff ratio of the staff at Goshen 
than at Bellevue. 

Q. Do you know of your own personal knowledge whether seclusion is used 
at other institutions? 

A. Yes, indeed it is. 

Q. Are the members of your profession in unanimous agreement about the use 
of seclusion? 

A. By no means. Some of my best friends would disagree with me. 

Mr. Hoffman. I have no further questions. 

CROSS EXAMINATION BY MS. THORPE 

Q. Doctor, your experience with adolescents in institutional settings has been 
limited to hospital settings, is that correct? 

A. That's correct. 

Q. You testified that you have seen a number of boys at Bellevue who have 
gone to the training school and ultimately wound up at Goshen Training 
School. Can you tell us specifically how many you know went on to Goshen? 

A. No, I really couldn't. Had I known that that might be a desirable statistic 
I could have gotten figures for how many go on to the trainnig schools, at least, 
let's say, over the past six months or a year. But specifically how many end up 
at Goshen, most of them do not go directly to Goshen, as you are probably aware. 
They go to one of the other training schools based on their age, and may go from 
the — from that training school on to Goshen. 

Q. That's the point of my question. The children are placed not directly at 
Goshen but at other training schools. 

A. Yes, I am aware of that. 

Q. So what I am asking you is do you know how many of the patients you 
have seen were transferred from the training schools to Goshen? 

A. The best I could give you is a rough guess. I would say that over the years 
there may have been a dozen or two that I have had contact with that have 
been on my service that may have ended up at Goshen. 

Q. That may have ended up at Goshen? 

A. That's a guess, yes. 

Q. Yes. You are not certain. 

A. No. 

Q. All right. Now, you also said that some of the youngsters you have seen on 
your ward came from Goshen to your ward? 

A. That's right. 

Q. Is that because they were very disturbed youngsters? 

A. Well, what usually happens is that a youngster is at Goshen, he may be 
manifesting — he will be in the training school system and he may be manifesting 
the usual aggressive behavior which is common to many, many kids, but then 



209 

something peculiar happens : he may either begin to act bizarrely as part of the 
aggressive behavior or separate from that, or he may become acutely suicidal 
and the state training school feels that they cannot deal with that and they need 
a hospital at that point. And that would be a prime reason for his coming to us. 

Q. So such a youngster would not be appropriately placed at the state training 
school in the first place, is that right? 

A. No, I didn't say that. He may have been quite appropriately placed in the 
training school in the first place but kids change, patients change. And there is 
a normal evolution of a psychiatric disturbance which may or — which may be 
abetted by various conditions under which one finds one's self, or quite inde- 
pendent of the conditions under which one lives. There is an evolution, in other 
words, if we take an adult paranoid schizophrenic at one point in his past he 
was not visibly paranoid schizophrenic to anybody. At a certain point later 
on he would have been possibly diagnosed by some psychiatrist as an incipient 
paranoid schizophrenic and by others still doubting it. And then at a later 
point maybe this would have been clear end then finally we would see the 
flowering of the full-blown psychotic process. So you do get spontaneous changes. 

Q. So the children that you have seen that came from Goshen were children 
who got worse in the course of their stay there, is that correct? Without 
reference to whether Goshen produced that or not, they got worse in the course 
of their stay there. . 

A. I would only object to your use of the word "worse." They — let's say that 
the manifestations of their disturbance changed. Whether it is worse or not is a 
debatable issue. 

Q. You testified 

The Court. Excuse me. Before we proceed, is there a comparable state institu- 
tion for girls to Goshen? 

The Witness. Yes. 

The Court. What's the name? 

The Witness. Well, I believe so, I am not sure. Brookwood is the comparable 
institution. 

Ms. Thorpe. Yes, Brookwood. 

The Witness. And Hudson is the 

The Court. Girls? 

The Witness. Yes. 
By Ms. Thorpe : 

Q. You testified that organically brain-damaged children have unprovoked 
explosions of violence. That was one of the examples you gave of unprovoked 
violence. 

A. Yes. 

Q. Such a child would not properly be at Goshen in the first place, wouldn't 
you agree with that? 

A. Assuming that our diagnostic skills were refined enough so that we could 
establish the presence of organicity on first contact with the patient, I would 
say yes. 

Q. You said there were other unprovoked instances of violence. Would you 
say that most of those would occur in psychotic children? 

A. I would say so, yes. 

Q. Doctor, at Bellevue on your ward psychiatrists of the ultimate responsi- 
bility for the way the children are handled, don't they? 

A. They do. 

Q. And the use of isolation would always be under the direct supervision of a 
psychiatrist, wouldn't it? 

A. Yes. 

Q. On your ward you wouldn't authorize staff to leave a child completely alone 
in isolation, would you? By "completely alone," T mean either not being in the 
room or not being immediately outside the door watching the 

A. No, that's not true. What I described earlier is that we placed a child in 
seclusion and we check on that child regularly. That doesn't mean that there is 
a staff member directly outside of the room. I would say that optimally if we 
could afford the staff and the budget permitted hiring that much staff, that there 
should be someone outside the room. 

Q. So you do believe there should be? 

A. I believe that that's better than not. But that's not our practice and it's 
essentially the realities that we determine that. 



210 

Q. You would agree, would you not, that isolating a youngster alone in a room 
is a severe and drastic measure? 

A. Not necessarily. You see, I think what we get into there is a bias that 
affects many of us, which is that — you know, I always compare, I try to compare, 
with what happens in the normal — let's say a healthy home, in a good home situ- 
ation, and that his parents will — the best of parents will send a kid up to his 
room at times, will deprive him of this or that privilege in regards to certain 
disbehavior, and this is a very essential part of growing up, because where this 
does not exist the child gets no sense of direction and no guidance. And I think 
really that more than what we talked a heck of a lot more about, namely, the 
giving or not giving of love, accounts for a lot of the social problems, specif- 
ically delinquency and antisocial activity that we see today. And I think that 
there is a very pronounced tendency to overreact to a child being alone by him- 
self. And I think that kids tell us very often, in many ways, that they want to be 
alone, by themselves, that they want to get away from people, people bug them. 
And it could be their peers on a ward such as ours or it could be a particular 
staff member that he wants to get away from, and I don't see that is a cruel or 
unnatural punishment. 

Q. Doctor, I wasn't suggesting that it would be severe if the child asked to be 
alone by himself. We are talking about forced isolation. 

Now, would you describe an isolation room at Bellevue, please? 

A. Yes. It is a pretty bare room. There is usually a mat, such as we use in the 
gym, on the floor. Otherwise, nothing else. Eventually because what we are con- 
cerned with is that a patient who is extremely angry may attempt to inflict per- 
sonal injury in the course of his anger and it is very strongly contraindicated to 
provide him with any objects that he could possibly use to do that. 

Q. So then, doctor, it is really not analogous, putting a child in an isolation 
roam at Bellevue, a seclusion room, as you call it, to a parent sending a child 
to his room at home where he has his own personal things and things to occupy 
himself, is it? 

A. It is not analogous? It is not parallel ; it may be analogous. 

Q. Would you agree the containment of violence, which isolation is, is strictly 
a management technique? 

A. I am not sure I understand your question. As opposed to what? 

Q. As opposed to constituting therapy in and of itself. 

A. No, I look upon it as most emphatically therapy. Therapy is wrong to the 
patient's most immediate needs. That's what therapy is. And if we are dealing 
with a patient who has lost control, his most immediate need is the reestablish- 
ment of those controls. And if we know from experience that that particular 
pa'ient responds most quickly to being placed in seclusion, why, that is the 
optimal treatment of choice at that moment. 

Q. Well, doctor, you recall, I presume, an article you wrote entitled Therapy 
Of Assaultive Psychiatric Patients, as a matter of fact, you referred to it earlier 
in your testimony, which was contained in Current Psychiatic Therapies pub- 
lished in 1973. 

Now, in the second paragraph of that article you state that the definitive 
approach to the treatment of assaultive patients is two-pronged, on the one hand, 
management or containment of the assaultive behavior, and simultaneous ther- 
apy of the basic psychopathological condition. And what I was asking you was 
if you don't — excuse me ; withdraw that last sentence. 

Now, as you go through this article you divide it up into management tech- 
niques and treatment techniques. And under management techniques you in- 
clude seclusion as one of the techniques. 

Now, what I was asking you was if you still agree with the view that you were 
putting forth in that article, and that is that isolation is a management technique. 

A. Yes, but it is a question of playing on words, I believe. I think that man- 
agement is treatment. If you are managing the problem that is being presented 
at the moment, you are treating. 

Q. Well, what do you mean, doctor, then, by the statement that management 
or containment of assaultive psychiatric behavior and simultaneously therapy 
of the basic psychopathological condition means? 

A. Therapy refers there to psychotherapy, which is talking therapy, which is 
aimed at getting at, as I said, what stirs up the patient's anger ; in other words, 
the making known to the patient that which he may not be able to understand, 
of what it is that brings him to the point of losing control. If he can become 



211 

conscious of that, if he can be made to see what provocations play a role, what 
happens to him when he is provoked in a particular way, this becomes a most 
potent means of helping him to establish the control in the long view over the 
process of growing up, let's say, as opposed to dealing with the crisis situation. 
When I talk about management there I am talking about crisis intervention, 
you realize? 

Q. Yes. 

A. Which is treatment. 

Q. All right. But then do I understand you to say that along with that form 
of agreement as you have now defined it there must be also the longer term 
psychotherapy in therapeutic intervention? 

A. Most emphatically. 

Q. Now, would you say that isolation without the accompanying therapy, the 
longer term therapy, psychotherapeutic intervention, we will call it, would be 
harmful to a patient, simply isolating him, then doing nothing further after he is 
calmed down? 

A. I would not consider it desirable ; I would need research to satisfy me that 
it is — if I had to guess I would say that what is harmful is the absence of psycho- 
therapy rather than the imposition of solution. 

Q. Doctor, are you under impression that Goshen provides treatments for the 
boys in confinement there ? 

A. No. Well, I don't know specifically, but I know that the patients have some 
opportunity to talk about their problems either with nursing staff or with other 
staff members at times, but I really don't know to what extent that is true. 

Q. Is your view of the appropriateness of permitting isolation or the use of 
isolation at Goshen based on the assumption that there is some opportunity for 
therapy, psychotherapy — psychotherapeutic intervention? 

A. Again, we have to distinguish between what is optimal and what one must 
do in dealing with overwhelming realities. 

When you are confronted with the overwhelming reality of a patient who is 
violent and who may in the course of his violence hurt another patient who may 
be several years younger or hurt a staff member or hurt himself, you have to 
address yourself to that as the primary concern at that moment. 

Now, you may also be faced with the fact that you have a shortage of staff, 
you may be faced with the fact that you cannot provide the psychotherapy that 
this patient should be having, which may have to be optimally in some cases 
very intensive psyehoanalytically ; these are realities that are based on the short- 
comings of our society and perhaps other issues as well. But we don't throw out 
the baby with the bathwater. We will be helping the patient more if we deal with 
the little that we can deal with than if we don't deal with that because we don't 
have the rest of the pie. 

Q. Doctor, you testified earlier that if it wasn't used properly isolation could 
be a harmful experience for a youngster, is that correct? 

A. Yes, I did say that. 

Q. Wouldn't you say that used properly its use involves followup with psycho- 
therapeutic intervention? 

A. Optimally, yes. 

Q. If a child was quiet and cooperative for a period of a half hour or more 
in an isolation room, would you authorize his release at that point? 

A. In all likelihood I would speak to him first. You know, I would find out 
what he is feeling and what he would like. And as I mentioned in my earlier 
testimony, it is sufficient in most cases for me that the patient tell me, "I am 
ready to come out," for me to release him from seclusion. And my staff operates 
the same way. A patient will not say he is ready to come out unless he really 
has regained his controls, you see. But if he has reached that point, then it is 
convincing and you know he is not pulling a fast one, then of course 

Q. But you are not referring to the patient's apologizing for the outburst or the 
behavior? 

A. No, that isn't what's important. 

Q. If he were able to write a coherent statement about the incident that led 
to his isolation, would you say that he should be released from the isolation 
room, or at least have someone in there with him at that point? 

A. A coherent statement or even an incoherent statement would make me want 
to speak with him to find out what he really wants to communicate. And it would 
be upon that that I would determine whether he should come out or not. 



212 

Q. Wouldn't you agree that it would be an ti therapeutic to punish a youngster 
for verbal expression of anger or hostility? 

A. Not necessarily. I think there we have to distinguish between anger and 
hostility. Anger — this is something that is a particular interest of mine — an - 
is usually an appropriate response to a particular stimulus. Hostility is quite 
a different matter and is generally inappropriate, displaced onto the wrong 
person, and generally involves a wish to hurt the other individual. Sometimes in 
quite physical terms ; but if not, at least by insult or abuse or something — put- 
downs, let's say, things of that sort . 

Q. Well, would you authorize isolation for a youngster who expressed anger? 
A. No, that alone would not be sufficient reason. 

Q. Would you authorize it for someone who expressed hostility? 

A. That alone would not be sufficient. 

Q. If a youngster was placed in isolation for either of these reasons, wouldn't 
it be likely that the anger or hostility would increase rather than decrease? 

A. If the — it depends on the expectations of the child. If the child feels that he 
is being treated unfairly his anger will certainly increase and/or his hostility. 
If his expectations are different, if he feels that this is appropriate treatment, I 
very often get kids telling me — I will always ask about parental abuse, for 
example, and one of the questions I will always put to kids is, "Do you feel 
that the punishment, that the beating you got, was justified or not? 

Do you feel it was right for your father to hit you?" And very often he will 
say, "Sometimes yes; sometimes no." So kids do distinguish. And I think what is 
important is that they have a concept of fairness, and if we address ourselves to 
that and relate to that I think we will be wrong less often. 

Q. Doctor, you certainly wouldn't justify a boy a choice of going either to 
church services or going into isolation, would you? 

A. No, I would not. 

Q. All right. Now. in such a situation, wouldn't the boy perceive isolation as a 
punitive measure? If that was the offer made you would agree that that would 
be perceived as punitive? 

A. Most emphatically. 

Q. Now, if boys were frequently threatened with isolation by staff to get them 
to comply with staff instructions, wouldn't you agree that the boys would always 
view being put into isolation as punishment? 

A. I would say that there is a high probability of that, yes. 

Q. In that case isn't it likely that a boy would become anxious or fearful when- 
ever he is sent to wing 1 where the isolation rooms exist or are located? 

A. In such a case you say. In the case where a kid is being threatened. I 
would say he would be angry. Whether he is frightened or not depends on other 
variables that, you know, I would have to know about. 

Q. That might produce violence on his part, might it not? 

A. It would produce anger. I suppose it again is a variable thing. Some kids 
get a little bit angry and they become violent and other kids can tolerate a tre- 
mendous amount of anger without becoming in the least bit violent. 

Q. Doctor, I show you Plaintiff's Exhibit 5-4, which are photographs of physical 
restraints. Would you authorize the use of any of these restraints on any of your 
patients at Bellevue Hospital? 

A. I don't know that the thing in the left-hand corner is. It looks like a snake. 

Q. This is a plastic device which acts as — somewhat like a belt. In other 
words, this portion of it gets put through here and it is pulled tight, and in order 
to get out of it it requires a metal clipper. You may assume all of this. 

A. Yes. 

Q. It requires a metal clipper to get out. 

A. The only thing that resembles anything that we use at Bellevue is the top 
item, which is the restraints, and in that case — I don't know what you call it, 
but the top, the wrist grips — I guess that's what they are — and that is not — 
never used with a lock which is attached to that particular exhibit. Manacle- I 
have never seen in our ward unless a policeman brought in a patient in manacles 
and they are immediately removed by my order or anyone else's order. 

And I don't know about the other item. I have never seen it. 

Q. Doctor, you testified earlier that some youngsters are very sensitive to being 
held because they have suffered great abuse in their previous life experiences 
in their homes, is that correct? 

A. That's correct. 



213 

Q Those experiences were— that you were referring to— were brutal experi- 
ences ; it was hostile touching that was going on, is that correct? 

\ Yes it is very variable again and it might be something— it might be out- 
rageous brutality of a very extraordinary kind, or it might be something as dif- 
ferent from that as a child being hit over the back of the head unsuspectingly 
bv the mother's boyfriend who is just kidding around with him but giving him 
a'good, hard wallop. There is a tremendous variety in the kind of physical abuse, 

obviously. . , . . .. . 

Q. Doctor, if a boy who suffered such abuse in the past were being held by 
human beings who were giving him the message that they carried, that they were 
trying to stop the violent behavior but that it was a message of caring and not 
hostility and brutality, wouldn't your opinion change about the advisability of 
having human beings hold children? 

A. The attempt is always to convey that message, but yonr question presup- 
poses that the message gets through to the child, and when a child is out of con- 
trol he is in what is a quasipsychotic state and his contact with reality is ex- 
tremely impaired. . 

Q. Doctor, you would certainly agree, would you not, that thorazine should 

not be used punitively ? 

A. I don't think any medication should be used punitively. 

Q. Would you say that a nurse is qualified to prescribe thorazine for a 

patient? . . , 

A. A nurse is not qualified to prescribe medication, only a physician is, and 
this is the one thing that distinguishes a psychiatrist's rights nowadays from 
a lot of other things that we share with other mental health professionals. 

The question in regard to a nurse's prerogatives is that very often a nurse — a 
nurse carries out a doctor's orders obviously. I authorize my staff in an emer- 
gency situation where life or limb is being threatened to — and this would apply 
to a nurse and it would apply to a nurse's aide and perhaps to any other staff 
member who happened to be on the scene at the time — to use medication in an 
extreme situation. I emphasize that, in an extreme situation where life or limb 
are literally threatened, even in the absence of a medical order to that effect, 
because what we are concerned with is making certain that nobody gets hurt 
at that point. The damage that may be done in terms of whatever we want to 
think of, overdosage or something of the sort, is very minimal indeed, and then 
what we then do is quickly, as quickly as possible — at Bellevue we are fortunate 
in that there is always a psychiatrist on duty in the hospital at any hour of the 
day we get a doctor to write an order after the fact. 

Q. Would you also agree that a nurse is not qualified to double the dosage 
previously prescribed by a doctor in a dosage of thorazine administered 
intramuscularly? 

A. I believe that it is illegal. 

Q. Would you say it would be dangerous? 

A. Not necessarily. It could be. Again it depends on the particular drug that 
we are talking about, and as I mentioned Mr. Hoffman's examination thorazine 
has a very wide latitude of safety so you don't run into serious trouble just by 
doubling. 

Q. But it would depend on the patient? 

A. It has a wide latitude with all patients. So patients are perhaps a good 
bit more sensitive to its effects than other patients. 

Q. Doctor, you said earlier that thorazine might be preferable to control 
violent behavior, is that correct? 

A. Yes, I did say that. 

Q. In your article again, Therapy of Assaultive Psychiatric Patients, in the 
section on management techniques as opposed to treatment techniques, you dis- 
cuss the use of medication, however you do not suggest in this article that thora- 
zine is an appropriate method of controlling — an appropriate medication to be 
administered for a patient who needs to be quickly subdued, is that correct? 

A. I don't remember really, but I suppose — 

Q. Well, I will read you the sentence, if you like. 

A. Yes. 

Q. You have talked earlier about maintaining patients on dosages of pheno- 
thiazines, chlorpromazine and some others, but that's on an on-going basis ; then 
you say sodium amatol, in injectable form, should always be available for the 
patient who may have to be quickly subdued. 

A. Yes. 



214 

Q. You do not suggest thorazine in there? 

A. Because, as I pointed out earlier, thorazine does not have that quick effect 
that sodium amatol has and would not be a suitable substance if you need to 
have quick results. 

Ms. Thorpe. Thank you. I have no further questions. 

The Court. Anything further? 

Mr. Hoffman. Just one or two questions. 

REDIRECT EXAMINATION BY MR. HOFFMAN 

Q. Doctor, do all of the boys that you treat at Bellevue respond to 
psychotherapy? 
A. No, they don't all get psychotherapy either. 



70 CIV. 4868 — JUNE 7, 1974 

Joe Pena, et al. 

V. 

New York State Division for Youth, et al. 

[In open court.] 

The Court. Good morning, ladies and gentlemen. Mr. Hoffman, are you ready 
to proceed? 

Mr. Hoffman. Yes, your Honor. 

The Court. All right. 

Mr. Hoffman. I will call Mr. Carlos Estrada. 

Carlos Estrada, called as a witness on behalf of the defendant, having been 
first duly sworn by the Clerk of the Court, testified as follows : 

DIRECT EXAMINATION BY MR. HOFFMAN 

Q. Dr. Estrada, what is your current position? 

A. I am the clinical director at the Boys' Industrial School in Topeka, Kansas. 

Q. What is your professional background and training? 

A. Psychiatry, child psychiatry. 

Q. Where did you receive your degree or your training in child psychiatry? 

A. At the Menninger School of Psychiatry in Topeka, Kansas. 

The Court. Are you saying "Menninger"? 

The Witness. Yes, Menninger. 

Q. Have you written any papers or articles on the subject of the treatment of 
children? 

A. Yes. 

Q. Will you tell the Court the title of the papers that you have written? 

A. I have written a couple of papers that are not yet published. One is en- 
titled "Treatment of the Deprived," and has to do with the treatment of children 
who have suffered severe degree of deprivation and abuse during their infancy 
and early childhood. And that as a result of this later developed into delinquent 
behavior. 

The other papers that I have written are papers for the training of the staff 
of the Boys' Industrial School. 

Q. Will you tell the Court something about the Boys' Industrial School where 
you are the director? 

A. Yes. The Boys' Industrial School is a state institution developed with the 
purpose of the care, treatment and education of disturbed, delinquent adolescent 
boys. It has a capacity for 190, but currently we usually have an average of 150. 

Q. Would you tell the Court the types of boys that are sent to the Boys' In- 
dustrial School? 

A. In terms of their commitment all of the students sent to the Boys' Indus- 
trial School have to be committed by the Juvenile and Probate Courts of the 
state in a finding of delinquency. That is being found .guilty of having committed 
an act that if they were adults they would have been found guilty of a felony. 

In terms of their age. there are two state facilities for delinquent youth ; one 
for younger children ages 13 to 15 in Atcheson, and one for the older youth, this 



215 

is Topeka Boys' Industrial School for children aged 15 to 18 on the average of 
admission, but we can retain them in residency until the age of 21. 

Q. What type of boys do you deal with in terms of their mental and emotional 
problems ? 

A. From a diagnostic point of view about 10 percent of the population would 
be considered psychotic, or mentally ill, both medically and legally. This first 
group are youth who chronically have problems in their perception of reality 
and have either perceptional distortions, such as hallucinations, or thought dis- 
orders, including delusions and so forth. 

The second group that comprises about 50 percent of the students is a group 
that we call borderline cases. That is youth who ordinarily are functioning and 
capable of distinguishing fact and fantasy, reality from wishes, but occasionally 
have episodes of lack of control and lack of touch with reality. 

So in effect they are psychotic for brief periods of time, but may go from a 
few minutes to a few days. 

The third and largest group of students is comprised of, that would be about 
50, 60 percent of the students, students who have chronic long-standing serious 
problems of behavior, and particularly in their relationships with other people. 

This is the group that we ordinarily call in psychiatry diagnosis the youth 
with character pathology, or character disorders. And there are several sub- 
groups within this larger group. 

Now, in regard to their background, the great majority of these children have 

had a very deprived background in which they have been abused and neglected, 

h emotionally and physically, for a great number of years. Their usual police 

record and legal background includes at least four years and five or more offenses 

that have been heard formally in court. 

All of them have been attempted to be helped through other methods than 
institutional. Such as counseling in the local centers, placement in boarding 
homes, foster homes, boys' ranches, and about one-third of them have also been 
placed in state hospitals previous to their commitment. 

So pretty much in the way the system of agencies that offer help for youth 
operates in Kansas, the Boys' Industrial School is the last resort before they 
are referred to the adult penal system. 

Q. Doctor, you described three categories of boys that you deal with. Do you 
encounter violent behavior from these boys? 

A. Certainly. 

Q. Do you find that the violent behavior predominates more in one category 
than in any of the other categories? 

A. No. The type of violent behavior is different in one group than in another. 
In both the psychotic and borderline group the violent behavior is unpredictable. 
Usually triggered by events that would not produce a violent reaction in most 
people, not planned and purposeless, or bizarre. It is typically the result of a 
reaction of panic or rage to a misinterpretation of a current event, such as 
voices that they are hearing, or other type of hallucination or delusion. 

The management of this type of violence is, of course, very difficult in the 
community, but it is a very easy procedure in an institution. These are the kinds 
of violent outbursts that can be controlled with medication and other means 
s That after a drug treatment has been started these problems disappear. 

The other type of violent behavior is the violent behavior that is not the result 
of an impulsive action resulting from a misinterpretation of current events, 
but is a style of dealing with frustration and relating to others that is a chronic 
and that is a part of the learning and the makeup of the person. 

Usually then this violent behavior is planned, premeditated and far more 
dangerous and usually takes very much into consideration the possibilities of 
being found and caught. 

So the persons or group involved in this type of violent behavior take many 
steps, usually unsuccessful, to avoid being caught in the act. 

Q. Doctor, is there a system at the Boys' Industrial School by which the boys 
can guide their behavior? 

A. Yes. 

Q. Very briefly would you just explain to the Court what that system is? 

A. We have a system of management of the student behavior and program that 
we call the step system because 

The Court. The step system? 

The Witness. The step system. 



216 

A. [Continuing.] Because it goes from steps from the responsibilities that are 
most fundamental and necessary and easy to acquire to the responsibilities that 
are more sophisticated and not a basic necessity, but a luxury, if you may wish, 
and together with this they then increase in the individual students' freedom, 
privileges and activities. So that at Step 1, which is admission, or the beginning 
step, the responsibilities and freedom and the privileges will correspond pretty 
much to that of a toddler, that is a child of around three years old, and at the 
end of the program, that is, Step 10, which is the pre-parole step, the responsi- 
bilities the demands on the student and the amount of freedom and privileges 
will correspond to those available to an ordinary sixteen year old in the 
community. 

In between each step has a gradation of more advanced demands and responsi- 
bilities paralleled with an increase in his privileges, freedom and area of free 
movement. 

Q. Doctor, do you have secure cottages and seclusion rooms at the Boys' 
Industrial School? 

A. Yes, we have a campus with 11 cottages. One is a community cottage, that 
is, that there are students on most of the program in the community either 
working or going to school or vocational training and come to the cottage in 
the evenings for recreation activities, therapy and to sleep. 

Then we have the open cottages, four of them, where the students can walk 
free in and out of the cottages into the different activities on campus. And we 
have the semi-open cottages that are cottages with the doors open, but most 
of the treatment activities, including classroom work, education and so forth, 
take place inside of the cottage. 

Then we have the closed treatment cottages, three of them, where the doors 
are locked in the building and there are 15 rooms of which five are seclusion 
rooms in each of these cottages. 

The program in these cottages takes place almost all of the psychotherapy, 
recreation, physical education, academic classes, and so forth, inside the 
building. 

Q. Doctor, will you describe how seclusion is used in connection with the 
step system that you spoke about before? 

A. Yes. Seclusion is the Step 0. The responsibilities of a student in a Step 1 
are those responsibilities that are absolutely indispensable in order to be able 
to relate in society, and they include, One, do not run away from the ins! 
tion ; Second, do not hurt yourself or others physically ; and Third, do not de- 
stroy or steal anybody else's property, including theirs. 

If the student breaks any of these responsibilities he is placed in Step 1. 
Step 1 simply means that he will have to be on a one-to-one supervision with 
a staff member in the open cottage. If after a student because of any violation 
of this Step 1 responsibility is placed in Step 1, he still continues or repeats 
the destruction of property or hurting or attacking somebody else physic: 
or attempts to hurt himself, then he will be dropped, so to speak, that is the 
word the boys use, to Step 0. 

Step is being placed in a seclusion room. In the closed cottages the seel': 
rooms are right there in the same building, and there are no seclusion rooms 
in any other cottage. 

So if the boy is to be placed in Step 0, then he is taken to the closed cc>- a 
for placement in seclusion. 

Now, Step 0, or seclusion level, step, has five levels. What we call the Level 
00 A, B, C and D. 

Step 00, which will be comparable to what is usually referred to as seclusion 
in the mental hospitals, is the step where a student is placed when he is abso- 
lutely out of control. He is trying desperately to attack or to hurt somebody, 
trying to break things, trying to hurt himself by banging his head on the floor 
or something like that. 

This Step 00, Level 00, lasts for whatever length is necessary for the youth 
to control himself, and usually does not go beyond an hour to two hours. 

During this state the student is taken to this room, and the room, the se- 
clusion room, is emptied of furniture, but he remains with his personal cloth- 
ing. 

The Court. Excuse me. What state was he in just prior to that? What kind 
of room? 

The Witness. If he is in this state he will be taken to the seclusion room 
and the furniture from the seclusion room 



217 

The Court. No. Before you take him to that room, what is the room he was 
in? When he was violent for two hours. 

The Witness. Oh, he might be violent anywhere on campus. 

The Court. No. No. I was trying to get straight what room he was in. You 
said he was there for about an hour or two. What kind of room was that? 

The Witness. Oh, this is in the seclusion room. 

The Court. In the seclusion room? 

The Witness. Yes. 

The Court. Then he goes to a different kind of seclusion room? 

The Witness. No. 

The Court. All right. 

The Witness. If he is in this very highly, very violent state, then — I was 
trying to explain the difference between a Level 00 and 0-A. 00 is only for 
the students in this highly agitated state and during this time the furniture 
that is available in the seclusion rooms, such as a desk, a bed, a chair and a 
small closet for their clothing, is removed because they could use these to harm 
themselves. And a staff member remains with the student usually until they 
are able to talk the student down, into calming down, including the need to 
restrain him physically. 

If he doesn't calm down pretty soon, in a matter of a few minutes, then they 
call the person in charge, usually a child psychiatrist, who comes and talks with 
the student, and if it is indicated he could be sedated with the medication so 
the whole procedure of this agitated state ordinarily doesn't go beyond a couple 
of hours. 

Q. Doctor, if I may interrupt you for a moment, does the staff necessarily re- 
main in the room with the boy when he is at the 00 level? 

A. In the 00 level, yes. When he is in this very agitated state, yes, because 
he could hurt himself. 

Q. What is the next stage after the 00 level? 

A. As soon as he calms down, then his furniture and the rest of his possession, 
if he has a radio and so forth, are brought in. But he remains in seclusion. The 
difference, the main difference between the Step 00, you know, there is what 
will be called in a hospital stripped seclusion. And Step 0-A which is not used 
in most hospitals, because in most hospitals as soon as the person is calmed 
down he comes back into the area where the general group of patients is. We 
don't use this procedure after a person has calmed down, we still keep him 
in the seclusion room, but he starts participating in his program of activities in 
a one-to-one supervision. 

' For example, if the students have psychotherapy, group psychotherapy or 
individual academic classes and the school has a period of physical education, 
and so on, and so forth, in a Step 0-A he can participate and he is encouraged 
to participate in all these previous activities of the program. 

The only difference is that he is supervised in a one-to-one basis. Whenever 
possible the activity is brought to him in the cottage and there are conference 
rooms and classrooms in the cottage available for him not to miss his class and 
not to miss his recreation or his therapy, and so on, and so forth. 

If this is not possible the teacher herself, or the physical education instructor 
will come and pick up the student in the seclusion room and take him to the 
school for him to finish his class. So he is in effect in seclusion during such 
times as he is not scheduled in some activity or not willing to participate. Par- 
ticipation in activities of this program is not required during this state. 

Q. During these intervening periods of time between activities when the boy 
is at O-A level, is a person necessarily in the room with him? 

A. Not at this time in 0-A, because the student is no longer in an agitated 
and highly dangerous state. But he is being observed frequently and, in effect, 
there is not that much time that he is not participating in activities. Unless 
he prefers to have more time for thinking and to be alone, as many of them do. 
Q. How long will a boy remain in the levels of seclusion? 
A. On the 00 step usually — well, for one thing, about half of the boys who 
become involved in any of this very dangerous behavior, such as physical harm 
to themselves or others, or to property, about half of them or, more than half, 
controlled simply by being placed on a one-to-one supervision in the original 
cottage. And the other half, most of them are calmed down simply by coming 
into seclusion, and they are in 0-A with their possessions simply by being moved 
from this thing that created the stress. 



218 

So that the boys who actually go to 00 and would need to be physically con- 
trolled for a while and their furniture taken away are very far and between. 
I think we have an incident like that maybe once a month in which we use the 

00 step. 

Q. For what period of time would a boy remain in the secluded wing going 

through the levels 0-A up to 0-D? 

A. There are three different considerations. One is that any student has tii 
right to request to go to the closed cottage, to the seclusion area whenever be 
feels he is tempted to do something he shouldn't do, that he feels furious with 
somebody, or he feels like he needs some time away from the stress. 

When he has himself placed voluntarily in either his room in the cottage or 
in the closed cottage, then whenever he feels he is ready to go back to his activi- 
ties he goes, and this with some students may vary from, you know, a half hour 
to occasionally a few days. But the student took the initiative to find a way to 
control himself, a boy doing something he would be sorry for later, and he has; 
the right to exercise his freedom and go back to his activities whenever he feels 
like. 

The second consideration Is that whenever a boy is placed in seclusion within 
24 hours the members of his treatment team, the head of the treatment team 
which is either a psychologist or a child psychiatrist, the social worker, the youth 
worker, would go and interview him, and the person or other staff person in- 
volved in the incident or the other student, the one involved in the incident that 
led to his being placed in seclusion, and if after this conference they feel that 
he should be back in the cottage, he is back before the 24 hours pass. 

If in considering all of the situation they decide that he is not ready to go 
back, then he will finish the seclusion program which is a program that will 
take ordinarily six days. 

Q. Will you tell the Court what the seclusion program is? 

A. The seclusion program in this closed cottage consists of a program of indi- 
vidualized counseling and activities with a one-to-one coverage in order to help 
the student do a number of things: One, reflect upon the circumstances thar 
triggered his emotional outburst, to gain some insight into the internal emotional 
conditions and problems that he was attempting to cope with with his behavior : 
and, second, in the cottage to help him put to practice this learning into the 
exercising of responsibilities and higher privileges during these steps through 
a six-day period, at the end of which if he has been able to advance in each of 
these steps, and this is very clearly specified what the responsibilities to be ex- 
ercised and what the the privileges in each one of these levels, then he goes 
back to his cottage. 

If a student has either been in and out from a Step to Step 1, you know, 
during several times, maybe a couple, three times during a month, or if he is 
not back in his cottage within a week, then a review conference is called where 
the treatment team and the staff attending the student gets together under the 
direcion of a consultant, usually one of the senior staff members or myself, to 
find out what the problem is that the youth is not making it. 

Q. Doctor, is seclusion used at your institution for what might be described as 
a treatment purpose? 

A. Yes. 

Q. Will you explain what the treatment purpose is? 

A. The student has a way to, one, control himself, put a stop to his impulsive 
or violent behavior and, at the same time, remove him from the temptation?. 
over excitement, over demands of the current situation that precipitated that 
outburst in the first place. 

These are the two basic purposes. Secondarily to this in specific instances for 
example, it helps those students who are in the process of trying to control som- 
kind of destructive behavior they are starting to see as self-destructive, such 
as lashing out to other people physically whenever thev are frustrated smh 

f* S SfK* S^ SUCh as runnin * a ™*y. but they are not yet capable of 4oi»g 
it, and they feel very much in a bind. 

,JJf°,!, he .r e °^ this ^ 0(Ulsion allows them the time while thev develop thes* 
controls themselves the control is provided by the institution, by the phvsic.i' 
boundaries Other students feel unable to give into the group pressure or to the 
pressure of another student. So they are very afraid that thev would gfve in to 
this pressure and become involved in activities that scare them. Such as hom »- 



219 

sexual activities, such as giving their possessions, such as running away, such as 
being involved in a delinquent plot, and so forth. 

The Court. "What do you mean by giving their possession? 

The Witness. Somebody might threaten them, to hit them if they didn't give 
them some money, another student, and they may feel in this instance that they 
cannot tell the staff in the cottage because they don't want to be disloyal, you 
know. A very misunderstood aspect of loyalty, but in any event they feel very 
much in a bind. So usually they may act up in order — usually by running away — 
in order to be placed in the seclusion room where they will be protected. 

Now, if we simply were to take care of their agitated states, they calm down 
and send them back to the cottage, we would not find out what triggered his 
running away, or their upset, but if we keep him there longer after he has calmed 
down and provide the opportunity for frequent diagnostic interviews to find out 
what triggered what happened, we will find out, and we usually do, that some- 
body else was threatening him and we can do something about it. 

Q. Doctor, do you use physical restraints at the Boys' Industrial School? 

A. Yes, we do. 

Q. Will you tell the Court in what situations you would use them? 

A. We use them very, very once in a while. There are some occasions in which 
a student would need to be physically restrained immediately in order to prevent 
serious damage to himself, to other persons or to property. Such as a student in 
the arts and crafts shop who is working with leather and gets hold of a knife and 
he is trying to cut another boy with whom he is angry about something. This 
requires an immediate intervention and holding physically that student. 

Now, very seldom the physical intervention will have to be sustained. In those 
situations in which the student cannot be let go physically because he will im- 
mediately go back into his violent behavior, with adolescents I prefer to use 
temporarily until the psychiatrist comes leather straps rather than physical 
holding. I would not advise this with small children, you know, to tie their hands 
with a leather strap, for example, because with small children it would be far 
more preferable to hold them physically until they calm down. 

But for a couple of big men on the staff, you know, to physically subdue a 
teenaged boy and hold him until he calms down has a very deleterious result. 
For one, this student is going to have a tremendous loss of face in front of this 
group. So we usually try to remove him right from the group immediately, you 
know. 

To have your friends, you know, witness the fact that several men, you know, 
had to control you physically is a tremendous loss of face. And if they don't let 
you go and treat you like a little boy, you know, that is a very embarassing 
situation. 

Second, this is, in adolescents, and by adolescents I will say, you know, any 
boy who already is showing secondary sex characteristics, I wouldn't keep hold- 
ing, you know, I would use the leather restraints instead because if you keep 
holding by one or two persons, you know, an adolescent boy, he and his friends 
are going to misinterpret this as a homosexual attack. And there is going to be a 
very traumatic experience, you know, to get over with. 

The Court. Why couldn't you get some women on the staff to hold them? All 
these boys have had mothers, haven't they? 

The Witness. Yes. 

The Court. Why couldn't you use women? 

The Witness. We have women on the staff and they occasionally help in this. 
But again, a boy, an adolescent boy, you know, would rather be physically sub- 
dued by a man than by a woman. If a women would attempt to try to subdue the 
boy, I wouldn't advise a woman to do it, you know, with an adolescent boy. 

The Court. Well, she might not have to do it, just approaching him might be 
enough, wouldn't it? 

The Witness. That's right. We have learned that, that the female staff often 
is more capable of helping a boy settle down and control him verbally, you know, 
than a man, than the male staff. But in terms of the physical control a boy will 
be far more embarrassed, you know, if it has to be physical control, far more 
embarrassed about being physically controlled by a women, you know, than by a 
man. 

Now, this I say, you know, might happen three, four times a year, you know, 
that the staff have to go as far as placing the leather cuffs on the boy's wrist. 
If this is the case, then myself, if it is in the evenings, or any of the other child 



220 

psychiatrists on duty, that is on weekends or evenings, would be called imme- 
diately. And we will come and try to talk with the boy and see if we can calm him 
down. 

When this is not possible to be done by talking, I, in the institution, we prefer 
to calm him down with medication rather than to allow him to continue, you 
know, tied up with handcuffs and kicking and trying to bang his head and so 
forth for a lengthy period of time. Because that wouldn't help him and it would be 
extremely embarrassing for him the next day when he recovers, you know, to 
find out to what extremes he went. 

In these circumstances when he is not calmed down, we tell the student that 
he is out of control, that this is not helping him, that we need to help him to 
control and that we are going to give him a medication to control him. 

The Court. Are we talking about psychotic people now? 

The Witness. Not necessarily so. Not necessarily psychotic. 

Q. Doctor, will you explain the institution's policy with respect to medication, 
and particularly the use of thorazine? 

A. Okay. In this state, you know, we tell him we are going to give him medica- 
tion, but he has a choice between taking it orally or being given in an injection. 
This is when the student is in a Step 00, in this highly acutely violent stage. 
Once the student has calmed down, and from any step above, a student has a 
right to refuse medication, you know, the psychotherapeutic medications that 
are for the purposes of helping a person with anxiety or depression. 

So the physician will discuss with him the fact that certain medication might 
help him in this and otherwise will answer all his questions, will explain the 
side effects or possible advantages, and if a student refuses to take it, he has the 
right to do so. And he can refuse to take it at any time. 

He might say, I want it, you know, now, and the physician will prescribe it. 
And, you know, the day after tomorrow he might change his mind and say, I 
don't want to take it any more. And the staff on duty who is to give him medication 
just make a notation that he has refused the medication and it is stopped. 

Q. With respect to seclusion, what is the policy of giving medication V 

A. Only on the Step 00 when the student is in this very highly agitated state, 
only then he doesn't have a right to refuse the medication. Now, he has a choice 
of taking the medication by mouth, that is, in a concentrate, in a glass of juice, 
or receiving it in an injection if he refuses. In I would say almost SO percent 
of the instances the person will say, I will drink it, I will take it by mouth. And 
we prefer it to be like this because there was at least some degree of attempt at 
self-control. 

So for all practical purposes we give very few injections of tranquilizing 
medication. 

Q. Would you give an injection of thorazine if the boy refused to accept oral 
medication ? 

A. If the student refuses to accept oral medication and he is in this very wildly 
violent state, I would give medication intramuscularly. Now, the type of medica- 
tion that I will give will depend on this student's condition and previous medical 
history. I might decide that certain medication would not be indicated because 
in the past when this was given he had a bad reaction to this, or a member of his 
family had a bad reaction to this, and there are some familial tendencies to 
react in a certain form. 

I might decide that his symptoms and psychiatric diagnosis will call rather for 
this medication than for this other. 

So that we generally use three types of medication under these conditions. 
You know, the most commonly used you would have to give a shot. One would 
be thorazine. The other that we use often enough is Haldol. And the third one 
that we use occasionally is librium intramuscularly. 

Q. What dosage of thorazine would you administer if you used thorazine? 

A. The dosage will be gauged according to the condition of the patient, you 
know, the patient might have been taken medication on an ongoing basis, so he 
might need less. The patient may be small or large, and that will have something 
to do with the medication. But in any event, after I decide, let's say, anywhere 
from 25 to 200 milligrams of thorazine in the shot, he will be observed in the 
following hour to decide if he needs more after an hour, or if there has been any 
problems with the medication. 

Q. Doctor, how many full-time psychologists do you have on your staff? 

A. Psychologists? 



221 

Q. Yes. 

A. Six. 

Q. How many full-time child psychiatrists do you have on your staff? 

A. Three. 

Q. How many social workers do you have on your staff? 

A. Twelve. 

Q. How many youth care workers do you have on your staff? 

A. 98. 

Q. Do you also have people in training at your institution? 

A. Yes. 

Q. Will you tell the Court the types of people who are in training and the num- 
bers of people that you have there? 

The Court. Well, I don't know if that is relevant. How many boys are there 
in your institution? 

The Witness. 150 average. Wednesday when I left we had 142 to be precise, 
but the average around the year is 150. 

Q. Doctor, in your opinion, do you believe that it is cruel or destructive to 
confine a boy in a room by himself? 

A. If he is in a very violent agitated state, it is very dangerous to confine him 
in this room alone. Under this very acute state of agitation he should have 
somebody right there. With counseling, physical restraints or drugs, this never 
goes beyond a couple of hours. Very, very seldom if ever. 

After he has calmed down to leave him alone by himself would be destructive 
if that's all you do, you know, to lock somebody up and forget about him and 
come to see how he is doing next day or at mealtime to bring him his food. But 
if you do not deprive the student of his capacity to become involved in the activi- 
ties under a one-to-one supervision, I don't think it is destructive. I think it 
provides the student a buffer from the temptations, peer pressure, and so forth, 
and as soon after the student is no longer in evident — out of control, he can 
participate in education, in sports, in recreation, in psychotherapy, go back to 
his cottage for the meetings with the small group leader, you know, his counselor, 
for meetings, daily meetings and the therapeutic community, you know, and so 
on, and so forth. 

Mr. Hoffman. Thank you, doctor. 

Ms. Thorpe. I have no questions, your Honor. 

The Court. No cross examination? 

Ms. Thorpe. No, your honor. 

The Court. All right, thank you. You may come down. 

[Witness excused.] 

United States District Court, Southern District of New York 

70 CIV. 4868 C.B.M. 
V. 

New York State Division for Youth, et al., defendants 

plaintiffs' post-trial memorandum, proposed findings of fact and 

conclusions of law 
Statement 

This action is brought pursuant to 42 U.S.C. § 1988 on behalf of all children 
placed with and paroled from the Goshen Annex for Boys, an institution within 
the New York State Training School system, challenging the use of isolation, the 
use of hand and feet restraints and the intramuscular use of thorazine or other 
tranquilizing drugs to control excited behavior of the children. Jurisdiction is 
conferred upon this Court by 28 U.S.C. §1343(3) and 28 U.S.C. §2201, et seq. 

The complaint in this case was filed on November 6, 1970. Although the orig- 
inal complaint challenged only isolation and the use of physical restraints, upon 
consent of both parties the constitutionality of the use of medical restraints was 
added as a triable issue. The complaint herein was filed shortly after the filing 
of a nearly identical action in Lollis v. Department of Social Services, 70 Civ. 
4750, which challenged similar practices at the Brookwood Annex, which is also 



83-303 — 77 16 



222 

part of the State Training School system. In each case a motion for a preliminary 
injunction was made. 

Judge Morris E. Lasker treated the actions as companion cases although he 
did not consolidate them. On December 18, 1970, he ruled that the isolation of 
the named plaintiffs in both Pena and Lollis constituted cruel and unusual pun- 
ishment in violation of the Eighth Amendment. Lollis v. Department of Social 
Services, 322 F.Supp. 473 (S.D.N.Y. 1970). He enjoined defendants in both cases 
from imposing extended isolation on inmates pending approval by the Court of 
regulations to be submitted by defendants. In the same opinion, Judge Lasker 
declined, because of an unresolved factual issue, to enjoin the defendants from 
handcuffing or binding the feet of children in the training schools, and denied 
defendants' motion to dismiss the complaint. 

Subsequent to the issuance of the injunction, but prior to approving the pro- 
posed regulations drafted by defendants, the Second Circuit Court of Appeals 
decided Sostre v. McGinnis, 442 F. 2d 178 (1971). Since that case appeared to 
stand for the proposition that a federal district court should not supervise in- 
ternal regulations of state prisons, 1 Judge Lasker modified his first order by 
eliminating the need for defendants to submit proposed regulations, and en- 
joined the defendants only from placing Pena (and Lollis) in isolation under 
the conditions alleged in the original complaints. In so doing, the Court acknowl- 
edged that the defendants advised the Court that "an injunction relating to one 
plaintiff would be 'respected by the State of New York to the same degree as an 
injunction on behalf of unknown and unspecified plaintiffs.' " Lollis v. Depart- 
ment of Social Services, 328 F.Supp. 1115, 1119 (S.D.N.Y. 1971). 

The case was declared a class action on January 19, 1971, by Judge Lasker, 
and on May 17, 1971, Judge Lasker issued a modified injunction which provided 
"that defendants be and they hereby are enjoined pending trial from placing 
plaintiffs or any member of the plaintiff class in isolation under the conditions 
alleged in the respect complaints." 

On October 28, 1971, having evidence of violations of the injunction, plaintiffs 
moved for an order amending or altering the preliminary injunction (1) to 
forbid the continued imposition of isolation upon members of the plaintiff class 
in excess of twenty-four hours; and (2) to forbid the continued imposition of 
isolation upon members of the plaintiff class in stripped rooms. As a result of 
that motion, counsel for plaintiffs and counsel for defendants met with Judge 
Lasker in a series of conferences over the next year or so. The motion was never 
ruled upon. Believing that a plenary hearing was more valuable to plaintiffs, on 
February 6, 1973, plaintiffs withdrew their motion to amend the preliminary 
injunction. 

Discovery was then undertaken which, by order of the Hon. Constance Baker 
Motley, was completed by October, 1973. On February 5, 1974 defendants moved 
for the convening of a three-judge court pursuant to 28 U.S.C. § 2281 to hear 
those portions of plaintiffs' case which sought to enjoin, on constitutional 
grounds, implementation of the state-wide regulations of the Division for Youth. 
Plaintiffs did not oppose the motion, and on February 15, 1974, Judge Motley 
granted defendants' motion in a written opinion. On March 18, 1974 both parties 
entered into a stipulation whereby plaintiffs withdrew their prayer for any 
injunctive relief which would prohibit defendants from taking any action 
authorized by state-wide regulations. 

On May 28, 1974, trial commenced before Judge Motley. The trial continued 
on May 29, 30, 31, June 3 and 7, 1974. 

SUMMARY OF TESTIMONIAL AND DOCUMENTARY EVIDENCE BEFORE THE COURT 

Plaintiffs called fifteen witnesses (six boys who had been incarcerated at 
Goshen, six experts, one named defendant, one agent of the defendant and one 
former ombudsman at Goshen). Additionally, plaintiffs introduced two hundred 
and eight exhibits in evidence. Defendants called five witnesses and introduced 
three exhibits. 

The following is a list of plaintiff's witnesses who were incarcerated at Goshen. 
All were subjected to isolation there. 



1 But see nost-Sosire decisions in Inmates of the Attica Correctional Fncilitii v. Rocke- 
feller, 453 F.2d 12 (2d Cir. 1971; Rhem v. McOrath, 326 F. Supp. 681 (S.D.N.Y. 1971) ; 
See also. Nelson v. Heyne, 355 F. Supp. 451 (N.D. Ind. 1972; aff'd. 491 F.2d 352 (7th 
Cir. 1974), cert, denied. 42 U.S.L.W. 3681 (1974) ; Inmates of the Boys' Training School r. 
Affleck, 346 F. Supp. 1354 (D.R.I. 1972). 



223 

1. Darcy Fowler was at Goshen from June 8, 1973 to December 10, 1973 (23). 2 

2. Alvin Morrison was admitted to Goshen in January, 1973 (51). The evidence 
does not indicate his date of release. 

3. William Ashley was at Goshen from December 13, 1972 to August 20, 1973 
(Exhibit 6-2). 

4. George Kesick was at Goshen from April 27, 1973 to February 6, 1974 
(Exhibit 6-7). 

5. Robert Frazier was at Goshen from January 2, 1973 to August, 1973 
(Exhibit 6-5). 

6. Sam Brown was at Goshen twice : from March, 1972 to November, 1972 and 
from February, 1973 to August, 1973 (144). 

The following is a list of plaintiffs' expert witnesses and a summary of their 
qualifications : 

1. Dr. James L. Curtis, Associate Dean and Associate Professor of Psychiatry, 
Cornell University Medical College. Dr. Curtis has been certified as a specialist 
in psychiatry by the American Board of Psychiatry and Neurology, holds a 
certificate of training in psychoanalytic medicine and has also had training in 
child psychiatry (158). He was formerly Chief Psychiatrist for the New York 
City Department of Social Services and, in that capacity, was the principal 
psychiatric consultant for the child-care facilities operated by the Department's 
Bureau of Child Welfare (159, 160). He has served as a consultant to a number 
of private child-care agencies (158, 159), and, as a member of both the Mayor's 
Juvenile Detention Center Visitation Committee (235) and the Citizen's Com- 
mittee for Children (160), has been active on task forces studying children in 
trouble with the law and the State training schools and City detention facilities 
in which those children are confined (160, 161). Dr. Curtis has also been Direc- 
tor of Psychiatry for the Mitchell Air Force Base which included an in-patient 
psychiatric service (215). 

2. Dr. Ira Goldenberg, holds a doctorate in clinical psychology and is Associate 
Professor of Education and Clinical Psychology at Harvard University (238). 
Prior to that appointment, he was first Director of the Residential Youth Center 
in New Haven, Connecticut, a facility for mentally disturbed and retarded delin- 
quents most of whom had a history of violent, acting out behavior. Following 
that he was Director of the Training and Research Institute for Residential 
Youth Centers, an organization which assisted in the development of facilities 
similar to his New Haven Center (238-240). Dr. Goldenberg has also served as 
a consultant to the Governor's Committee on Law Enforcement and the Admin- 
istration of Criminal Justice in Massachusetts on problems of juvenile delin- 
quency and the development of alternatives to the juvenile institutions being 
closed down in that state (241). He has published two books dealing with delin- 
quency and youth services (241, 242). 

3. Dr. Edward Kaufman, certified as a specialist in psychiatry by the Ameri- 
can Board of Psychiatry and Neurology, is Clinical Professor at Mount Sinai 
College of Medicine and collaborating psychoanalyst at the Columbia Psycho- 
analytic Institute (553). He is the former Chief of Psychiatric Services at Lewis- 
burg Penitentiary and also served as Director of Prison Health Services for the 
New York City prison system. Dr. Kaufman has held academic appointments at 
Albert Einstein College of Medicine and at the College of Physicians and Sur- 
geons of Columbia University and was Director of an in-patient unit at the New 
York State Psychiatric Institute (553). Currently, he is also Chief Psychiatrist 
of the Lower East Side Service Center in New York City and Chairman of the 
American Psychiatric Association District Branch Committee on Prisons (554). 

4. Dr. Jonathan O. Cole, a psychiatrist and noted specialist in clinical psycho- 
pharmacology, was in charge of the Psychopharmacology Research Branch of 
the National Institute of Mental Health for eleven years. He has conducted nu- 
merous studies of thorazine and other phenothorazines, winning an award from 
the American Psychiatric Association for one of them (339) Dr Cole is Pro- 
fessor of Psychiatry at Tufts Medical School and is former Chairman of the De- 
partment of Psychiatry at Temple University Medical School, as well as former 

^ n ^ tei l den L 0f Boston State Hospital (337, 338, 347). He was also Director 
of the Boston Mental Health Foundation, one of whose functions was to operate 
a program i n Boston for hard-core delinquents for the Massachusetts Youth 

wi^inSed rS lD parenthesis refer t0 P a ^ e numbers of the trial transcript unless other- 



224 

Service Board (338, 372). Dr. Cole has published approximately one hundred 
and fifty articles, primarily in the field of psychopharmacology, a list of which 
is in evidence as Exhibit 8-2. 

5. Dr. Fritz Bedl, holds a doctorate in clinical psychology and is a licensed 
psychoanalyst. He was Chief of the Child Research Branch of the National In- 
stitute of Mental Health for six years and then became Distinguished Professor 
of Behavioral Sciences at Wayne State University in Michigan (393). He has 
served as a consultant to numerous institutions for aggressive and delinquent 
children and is a past president of the American Orthopsychiatric Association 
(395, 396). Dr. Redl has operated three facilities for aggressive, disturbed 
children (394). He has written extensively in this area and his bibliography is 
in evidence as Exhibit 8-1. 

6. Miriam. Pew holds a Masters Degree in Social "Work and is currently with 
the Center for Youth Development and Research at the University of Minnesota 
as a trainer of youth workers in various facilities. She also serves as a consultant 
to a number of group homes for adolescents. She is the former Director of a 
program providing services for misdemeanants both prior and subsequent to their 
release from jail in Ramsey County, Minnesota. 

The following is a list of tbe other witnesses called by plaintiffs and a descrip- 
tion of their roles : 

1. Horace Belton is employed by the New York State Division for Youth as a 
Program Supervisor. Mr. Belton formerly served as an Executive Assistant to the 
Director of the Division for Youth and as a Middle Manager (477) . 

2. Milton Luger, a named defendant in this action, is the Director of the New 
York State Division for Youth (652). 

3. James Silbert was formerly employed by the Division for Youth as an om- 
budsman assigned to the Goshen Annex for Boys (813, 814). 

Defendants called the following witnesses : 

1. Dr. Michael G. Kalogerakis is Clinical Psychiatrist of the Adolescent Inpa- 
tient Service at Bellevue Hospital, a public hospital in New York City. He has 
been affiliated with Bellevue since 1959 when he completed his residency in psy- 
chiatry there. He is past president of the Society for Adolescent Psychiatry 
(595).' He has written a few articles on assaultive psychiatric patients and has 
edited a book about disturbed adolescents (596). 

2. Dr. Carlos Estrada is Clinical Director at the Boys' Industrial School in 
Topeka, Kansas (783). He has received training in child psychiatry (784). 

3. Charles H. King is Deputy Director of the Division for Youth in charge of 
rehabilitation services (692). 

4. J. Thomas Mullen is a Youth Division counselor trainee employed at Goshen 
(736). 

Due to the length of the trial and lack of additional time, the parties agreed 
to stipulate to the introduction into evidence of certain portions of the Examina- 
tion Before Trial of Norman Catlett, former Director of the Goshen Annex, as 
Plaintiffs' Exhibit 11-1 and the balance of that Examination as Defendants' 
Exhibit D. 

United States District Court 
Southern District of New York 

stipulation — 70 civ. 48c8 

Joe Pena, et al., plaintiffs 

v. 

New York State Division for Youth, et al., defendants 

It is hereby stipulated and agreed by and between the attorneys for the plain- 
tiffs and the attorneys for the defendants that for the purposes of this action 
the following facts are admitted as true. 

1. Seperate medical files, case files, AC (Administrative Committee) files and 
room confinement files are maintained for each child at the Goshen Annex. 
When a child is released from Goshen, the materials kept in the medical, case 
and room confinement files are left intact, but the materials kept in the AC file 
are either destroyed or discarded. The memoranda kept in the AC files concern 



225 

the imposition of Wing I status, detention status and reception status and the 
reasons therefor. Materials kept in the AC files normally are not kept any place 

With respect to confinement to a room on Wing I, the memoranda contained 
in the case, AC and room confinement reports at Goshen are intended to convey 
the elements of each incident noted. 

2. On March 11, 1974, regulations concerning the placement of children on 
Wing I and physical and medical restraints, were promulgated by the new Direc- 
tor of the Goshen Annex, J. Thomas Mullen. 

3. The following abbreviations are frequently found in Goshen records : 
AC — Administrative Committee 

HOCW— Head Child Care Worker 

SOCW — Senior Child Care Worker 

ypw — Youth Parole Worker (Social Worker) 

RC — Room Confinement Status 

W/I — Wing I (either the location or the status) 

WTS — Warwick Training School 

Det. — Detention Status 

SP — Special Program 

YDC — Youth Division Counselor (Social Worker) 

4. Through February 1974 the Wing I Program Summary in the monthly re- 
ports at the Goshen Annex, contained the list of children who were on Wing I 
status and the dates they were on such status. The Wing I Program Summary 
now is intended to reflect the children who are placed in a Wing I Special Pro- 
gram pursuant to the new regulations which were promulgated by the new Direc- 
tor of the Goshen Annex on March 11, 1974. The Wing I Program Summary now 
also includes children who are placed on Wing I for orientation. 

'5. Through February 1974 the Wing I Summary in the monthly reports of the 
Goshen Annex contained the list of children who were in "detention" status, and 
the date, length of time and summary of the reason in each instance. 

6. Unlike detention status and room confinement status, reasons for the im- 
position of Wing I status are not recorded in the Wing I Program Summary, but 
such information may be contained in the child's case record. 

7. The terms "detention status" and "Wing I status" are no longer used. The 
new regulations promulgated on March 11, 1974, provide that a child who is so 
disruptive that he cannot function in a segment of the regular program (or who 
prevents other children from functioning in a segment of the regular program) 
may be specially programed from Wing I, and, a child who is so disruptive that 
he cannot function in the total program, may be specially programed from Wing I 
for periods exceeding one day. The regulations also require that when a child 
is placed in special program his door must remain open and educational and 
recreational activities must be provided for him by the staff. 

8. Through February 1974 "standing" was a form of punishment which was 
imposed by the staff. A child was required to "stand" for anywhere from one-half 
hour to three hours in a designated spot without moving or saying anything. 
Children were often required to "stand" either with their backs to or facing a 
group of other children. The new regulations prohibt "standing." 

9. The failure of a child to stand or to stand "properly," has lead to place- 
ment in a room on Wing I in detention status. 

10. The notation on a record that a child failed to "respond" means that he 
did not do what he was instructed to do. 

11. Through February 1974, children who were confined to a room on Wing I 
were required to discuss the incident which resulted in their being put in the 
room before they were considered for release from the room. Failure of the child 
to participate in such a discussion resulted in his continued confinement in the 
roOm. 

12. Through February 1974, children were required to apologize and/or make 
a "positive commitment" to follow the rules and regulations of the institution 
before they were released from confinement in a room on Wing I. The new regu- 
lations require that a youngster lie released from room confinement when he is 
no longer a danger to himself or others. 

13. The portion of the Room Confinement Report [Form DY 750.1 (2/72)] 
which gives the date and time a child was "Placed in Room Confinement" indi- 
cated the date and time the child was placed in or released from room confine- 



83-303 O - 77 - 17 



226 

ment status, and not necessarily the date and time he was confined to or released 
from a room on Wing I. Through February 1974, a child may have been placed 
in a room on Wing I and may have been assigned detention tstatus, room confine- 
ment status and Wing I status or any combination of those statuses or any com- 
bination of those statuses without ever leaving the particular room. Under the 
new regulations, a child's status may be converted from special program status 
to room confinement status only if he is a physical threat to himself or others. 

14. Through February, 1974 there was no limit on the number of hours a 
child may have been held in "detention status" or "Wing I status." Under the 
new regulations a child who is in Wing I Special Program because he is so dis- 
ruptive that he cannot function in a segment of a regular program, is to leave 
the Wing I area as soon as he can function in whatever segment of program he 
was disruptive. 

15. Through February, 1974, there was no requirement that a child in deten- 
tion status or Wing I status be visited by any particular category of staff. 
Under the new regulations a child who is placed in Wing I Special Program 
must be seen, if time permits, by a Senior Child Care Worker from his team, a 
Head Child Care Worker on duty, a Youth Division Counselor (social worker) 
from his team, and if a problem involves school, a teacher and/or the education 
supervisor. 

16. Children are and have bene placed in a room on Wing I for reasons other 
than that they constitute a serious and evident danger to themselves or others. 
Under the new regulations they may be placed in Wing I Special Program when 
they are so disruptive that they cannot function in a segment of the regular pro- 
gram or in a total regular program. 

17. In those instances in which a child is placed in a room on Wing I because 
of a violent outburst of anger, the child may not be released from the room as 
soon as he has calmed down. Under the new regulations he is to be released 
from special program when he can be returned to a segment of the regular pro- 
gram without disrupting it, or when he can be returned to a new segment of 
program. ' 

18. Although the "Visitors to Child in Room Confinement" form requires the 
notation of the time the visit started and ended, the latter time may or may not 
be noted. Where noted, visits by the child care workers are usually five minutes 
to ten minutes in length. 

19. Through February, 1974 it was a common practice to release children from 
confinement in a room on Wing I at 9 :30 p.m. 

20. Children were ordinarily locked in their rooms at 9 :30 p.m. 

21. Each child is assigned a single room at Goshen. 

22. Through February, 1974 the term "Special Program" referred to confine- 
ment to a room on Wing I. Under the new regulations the term currently refers 
to a Wing I Special Program. (See Regulations of Goshen Annex, dated March 
11, 1974, annexed hereto). 

23. The forms which bear the notation "jb :8/72-2000" or "BE" in the lower 
left hand corner indicate when visual checks on a child placed in room confine- 
ment were made and the time the child was out of the room for any purpose 
(e.g. to see a doctor, recreation). The notations on these forms, together with the 
notations on the "Visitors to Child in Room Confinement" forms, record the total 
number of visits during a child's stay in room confinement. 

24. Through February, 1974, the Administrative Committee had to approve the 
release of a child from room confinement status. Under the new regulations a 
child is to be removed from room confinement as soon as he ceases to be a danger 
to himself and/or others, and this decision does not have to be reached by 
Committee. The Director is to be notified of the removal. 

25. Through February, 1974, if a child was in confinement in a room on Wing 
I because of trouble with a staff member, the child was not ordinarily approved 
for release by the Administrative Committee until the particular staff member 
in question bad given bis approval. 

26. The Head Child Care Worker on duty or the Director or the Assistant 
Director may dec!de whether or not a child is placed in a room on Wing I. The 
Head Child Care Worker must notify the Director or Assistant Director if he 
takes such action. 

27. The notation "Return via (or through) Mr. ' means that the 

particular staff member referred to bad to approve the child's release from con- 
finement in a room on Wing I. 

28. The term "Security Wing" refers to Wing I. 



227 

29. Through February, 1074. children who ran away either from the institu- 
tion or while off campus were confined to a room on Wing I upon their return 
to the institution. 

30. When children are admitted to Goshen, a PRN order for intramuscular 
injections of thorazine is routinely obtained by a registered nurse by telephone 
from a doctor who has never personally examined the child. 

31. It was not the practice of the nurse who ^ave an intramuscular injection of 
thorazine to make checks on the child during the hour following the shot. The 
nurse's office is located on Wing I across the hall from the rooms which are 
used for room confinement and special program. Under the new regulations, 
between 7 a.m. and 10 p.m., a registered nurse must visit a child within the 
first hour after administering the medication. 

32. Through February, 1974, upon admission to Goshen, children were confined 
in a room on Wing I for periods of up to a week. The new regulations provide 
that where practicable and feasible, a child is to be placed on a regular wing 
within 48 hours. 

33. No complete set of rules and regulations which specifies what conduct will 
result in a child's confinement to a room on Wing I is made available to each 
child when he enters the institution. 

34. Social workers are not on duty on Saturdays and Sundays and normally do 
not see children confined to rooms on Wing I on those days. 

35. The term "Transportation" unofficially refers to movement of children 
about the facility. 

Dated : New York, New York, March 22, 1974. 

Louis J. Lefkowitz, 
Attorney General of the State of Neiv York. 
Hillel Hoffman, 
Assistant Attorney General. 
Charles Schinitsky, 
Legal Aid Society, Attorney for Plaintiffs. 



Medical Regulations Prior to Pen a Trial 
subtitle e youth 

(1) Review and request for extension of room confinement. — A review of the 
necessity for continued room confinement shall be made prior to the beginning of 
each new 24 hour period by the superintendent (or director) or acting super- 
intendent (or director). Room confinement may be extended beyond the 24 hours 
only with the approval of the director of the division for youth or designee. Ap- 
proval shall be obtained prior to the beginning of each 24 hour period. Initially, 
such requests may be made orally (by telephone). The reqeust must then be sub- 
mitted in writing on forms designated by the division. This written request must 
be forwarded to the director of the division for youth or his designee within 24 
hours of the oral request. 

(m) Every effort shall be made to return the child to the regular program of 
care as quicklv as possible. 

Historical Note.— Sec. added, filed Feb. 9, 1972; amd. filed July 18, 1973 eff. 
July 18, 1973. Amended (a), substituted new (j), relettered (k)-(l) to be (1)- 
( m ) and added new ( k ) . 

168.3 Use of physical and medical restraints. — (a) Physical restraints. Physi- 
cal restraints shall be used only in cases where a child is uncontrollable and con- 
stitutes a serious and evident danger to himself or others. They shall be removed 
as soon as the child is no longer uncontrollable. If restraints are placed on a 
child's hands and feet, the hand and foot restraints are not to be joined, as for 
example, in hog tying. When in restraints, a child may not be attached to any 
furniture or fixture in the room. Nothing in this section shall preclude the use 
of restraints in the transportation of a child from one institution to another. 

(b) Medical restraint. — For the purposes of this Part, medical restraint shall 
mean medication administered either by injection or orally for the purpose of 
quieting an uncontrollable child. 

( 1 ) Medical restraint shall be administered only in situation where a child 
is so uncontrollable that no other means of restraint can prevent the child 
from harming himself. 

(2) Medical restraint shall be authorized only by a physician and be admin- 
istered only by approved personnel. 



228 

(c) Reporting requirements. — Use of physical and medical restraints shall be 
reported, pursuant to section 168.2, subdivision (j). 

Historical Note.— Sec. added, tiled July 18, 1973 eff. July 18, 1973. 

168.4 Group confinement. — (a) Group confinement shall be construed to in- 
clude situations where a child is separated from the general population and 
normal daily program by confinement in a locked cottage or living unit. 

(b) Group confinement shall not be used as punishment. — It shall be used only 
in cases where a child constitutes a serious and evident danger to himself or 
others, is himself in serious and evident danger, or demonstrates by his own be- 
havior or by his own expressed desire, that he is in need of special care and at- 
tention in a living unit separate from his normal surroundings. 

(c) Each institution wishing to institute a group confinement program must 
submit a detailed description of the program, including regulations governing its 
administration to the director of the division for youth for approval. 

(d) Each institution administering an approved group confinement program 
shall maintain a daily log indicating the number of children in group confinement 
and their period of stay in the program. This information shall be forwarded to 
the director or his designee monthly. 



Medical Regulations Subsequent to Pena Trial 
subtitle e youth 

(1) Review and request for extension of room confinement. — A review of the 
necessity for continued room confinement shall be made prior to the beginning of 
each new 24 hour period by the superintendent (or director) or acting super- 
intendent (or director). Room confinement may be extended beyond the 24 hours 
only with the approval of the deputy director of rehabilitation services or 
designee. Approval shall be obtained prior to the beginning of each 24 hour 
period. Initially, such requests may be made orally (by telephone). The request 
must then be submitted in writing on forms designated by the division. This 
written request must be forwarded to the deputy director of rehabilitation serv- 
ices or his designee within 24 hours of the oral request. 

(m) Every effort shall be made to return the child to the regular program of 
care as quickly as possible. 

Historical Note.— Sec. added, filed Feb. 9, 1972; amds. filed: July 18, 1973; 
May 23, 1974 eff. May 23, 1974. Amended (c), (f) and (1). 

168.3 Use of physical and medical 7-estraints. — (a) Physical restraints. Physi- 
cal restraints shall be used only in cases where a child is uncontrollable and con- 
stitutes a serious and evident danger to himself or others. They shall be removed 
as soon as the child is controllable. Use of physical restraints shall be prohibited 
beyond one-half hour. If restraints are placed on a child's hands and feet, the 
hand and foot restraints are not to be joined, as for example, in hog tying. When 
in restraints, a child may not be attached to any furniture or fixture in the room. 
Nothing in this section shall preclude the use of restraints in the transportation 
of a child from one institution to another. 

(1) The division shall prohibit the utilization of foot manacies. 

(2) Physical restraints may be utilized beyond one-half hour only in the 
case of vehicular transportation where such utilization of physical restraints 
is necessary for public safety. 

(b) Medical restraint. — For the purposes of this Part, medical restraint shall 
mean medication administered either by injection or orally for the purposes of 
quieting an uncontrollable child. 

(1) Medical restraint shall be administered only in situations where a 
child is so uncontrollable that no other means of restraint can prevent the 
child from harming himself. 

(2) Medical restraint shall be authorized only by a physician and be 
administered only by a registered nurse or a medical doctor. 

(c) Prn orders of psychiatric medication. — A pro re nata order, authorizing a 
registered nurse to administer prescribed psychiatric medication, for purp-ses of 
crisis intervention, may lie used by the Division for Youth pursuant to the follow- 
ing guidelines : 

(1) Prescription by medical doctor. — Before any Prn order may be pre- 
scribed, a medical doctor must examine the ehi'd and determine the need 
for such an order in terms of the individual child's ongoing treatment needs 



229 

at the facility. These Prn orders shall be prescribed on an individual basis 
and shall not be prescribed pro forma to all children at the time of their 
arrival at a facility, as follows : 

(i) The medical doctor must sign the order and the medical doctor 
must provide specific instructions and guidelines for the nurse. 

(ii) Periodic review of all Prn orders must be made by a medical 
doctor, monthly, including physically examining the child. 

(iii) At the time of the periodic review, the medical doctor must indi- 
cate, in writing, reasons for his continuing the Prn order. 
(2) Administration by registered mirse.—A registered nurse may admin- 
ister a Prn order when the actions of the child clearly present a danger to 
himself or other residents, as follows : 

(i) She must physically examine the child and refer to the child's 
medical record including the specific instructions left by the medical 
doctor for utilization of the Prn order. 

(ii) The pulse and blood pressure of children receiving such medica- 
tion must he taken during the first half by the nurse and periodi- 
cally thereafter until his release. 

(iii) The nurse must keep a record indicating the results of those 
examinations and shall prepare a medication report indicating reasons 
giving rise to her dispensing the medication. 

(iv) If the initial or subsequent examination by the nurse reveals the 
development of any symptoms indicating an adverse reaction to the 
medication, she shall immediately notify the medical doctor, 
(d) Reporting requirements.— Use of physical and medical restraints shall be 
reported, pursuant to subdivision (j) of section 168.2 of this Part. 

Historical Note.— Sec. added, filed July 18, 1973; amds. filed: Aug. 2 ,1974; 
Feb. 26, 1975 eff. Feb. 24, 1975. 

16S.4 Group confinement. — (a) Group confinement shall be construed to 
include situations where a child is separated from the general population and 
normal daily program by confinement in a locked cottage or living unit. 

Hi) Group confinement shall not be used <;s punishment. — It shall be used 
only in cases where a child constitutes a serious and evident danger to himself 
or others, is himself in serious and evident danger, or demonstrates by his own 
behavior or by his own expressed desire, that he is in need of special care and 
attention in a living unit separate from his normal surroundings. 

(c) Each institution wishing to institute a group confinement program must 
submit a detailed description of the program, including regulations governing 
its administration to the deputy director of rehabilitation services for approval. 

(d) Each institution administering an approved group confinement program 
shall maintain a daily log indicating the number of children in group confine- 
ment and their period of stay in the program. This information shall be for- 
warded to the director or his designee monthly. 

(e) The ombudsman for each institution administering an approved group 
confinement program shall have access to the daily log and the confinement 
area. It shall be his responsibility to report any deviation from the approved 
program to the institution's superintendent or director and, in an appropriate 
case, he may include documented deviations in his ombudsman's reports. 

(f) Where institutions instituted group confinement programs prior to the 
adoption of this section, they shall submit detailed written program descrip- 
tion and regulations to the deputy director of rehabilitation services within 
.".n days from receipt of notice of adoption of this section. Any institution failing 
to have an approved program within 60 days of the adoption of this Part, shall 
terminate the use of group confinement. 



Excerpt From Transcript in Nelson v. Heyne 
e. the t'se of injection's of thorazine 

Thorazine (technically called chlorpromazine (339-340)) is an anti-psychotic 
drug which is principally used for the treatment of schizophrenic states and 
"severely agitated depressions" (341. 582). According to Dr. Cole, who is a 
specialist in psychopharmacology, thorazine is of questionable value in other 
conditions (341, 348). It is a drug which should be given for treatment purposes 



230 

only and not as a behavior control device (366, 367). It is usually administered 
orally, but may be given intramuscularly (342). 

There are a number of adverse side effects associated with the use of thor- 
azine. Dr. Cole described it as "clearly an unpleasant sedation" (344). The 
patient feels "strange", "disconnected", "sluggish", ••miserable", "lightheaded", 
"not at all comfortable", and sometimes has difficulty breathing (344, 354, 582). 
( Both Anthony A. and George Kesick reported difficulty in breathing after re- 
ceiving an injection (125, 574).) 

Thorazine also produces a drop in blood pressure, called orthostatic hypo- 
tension (341, 583), which causes the person to feel dizzy or even to black out 
entirely. If this effect were severe the patient would be in "shock' (343). 
Dr. Cole stated that the duration of these effects is from 6 to 12 hours although 
since intramuscular thorazine is not usually administered to non-schizophrenic 
persons, he has not observed many non-psychotic people with a single dose and 
he said that there is some indication that the duration of the action is longer 
in such people (3~>4, 378). 

Other effects of the drug include dystonia, a state in which the muscles around 
the face and neck go into spasm, jaundice (although not permanent or serious), 
Parkinsonian symptoms' which include shuffling gait, tremor of the hands, drool- 
ing and a mask-like face, a lowering of the seizure level for epileptics, muscular 
discomfort in the legs, and agranulocytosis which is a severe drop in white 
blood cells, although this latter effect occurs in only one out of every 2,000 to 
5,000 patients (341, 342, 583, 591). Additional side effects mentioned by 
Dr. Kaufman are skin disorders and changes in the patient's electrocardiogram. 
Ho said he had seen a patient whose heart had stopped from one dose of 
thorazine (583). 1 

Dr. Cole said it is not possible to determine in advance if any of these side 
effects will occur, although if a patient is being 'maintained on thorazine orally 
or has received an injection previously without adverse reaction, the possibility 
of negative side effects from a future injection is "somewhat less" (342, 379, 380). 
However, the adverse possibilities are not eliminated altogether as there are 
variations in a patient's state and in the rate of absorption from different spots 
and different, injections (380). Dr. Cole also stated that there is not even a 
clear relationship between dosage and the probability of side effects. One may 
suffer severe side effects from a low dose (342). 

Dr. Kaufman testified that if thorazine is given intramuscularly, there is a 
peak pharmacologic) 1 level which is 10 times higher than that which occurs 
when it is given orally. Thus, when given by injection the side effects described 
above are 10 times more likely to occur (584). 

Defendants have stipulated that it is their practice to obtain a standing order, 
known as a "PRX" order, for intramuscular injections of thorazuie for each boy 
upon admission to Goshen (Pre-trial Order. §111, 16) . Such an order permits 
a nurse, at her discretion, to give the medication in the dosage designated in 
the order at any time (345). 

Dr. Cole and Dr. Kaufman were critical of both the general use of thorazine 
itself and of the practice of automatically obtaining standing orders for its 
use for all boys at Goshen. They said that these practices are not acceptable 
by current medical standards (345, 584). 

Both said thorazine is a drug used principally for treatment of psychotics 
(341, 582). Dr. Cole said that there is no good evidence that thorazine itself is 
useful for the usual conditions manifested by juvenile delinquents (3 l 5, 346) : 
personality disorders, asocial or anti-social personalities or gang delinquency 
(381, 382). He considers thorazine an inappropriate drug to use for these chil- 
dren (3^1), with two exceptions. It is medically permissible to writ a PRN 
order for thorazine for a psychotic child who ought to be in a state hospital and 
for one who is (1) on on-going anti-psychotic medication. (2) do'ng somewhat 
better on it but still out of control some of the time, so that (3) there is a short 
period when a PRX order might be necessary while the doctor is adjusting the 
maintenance dose (390). 

Dr. Kalogerakis al«o indicated that although Bellevue gives thorazine to non- 
psychotic patients (623), "more likely than not: it would give an injection of 
thorazine to a patient who is already receiving it as part of his overall treatment 



1 Both Dr. Colo and Dr. Kaufman testified to additional offers nr^duced bv lon^-'orm 
use of Thorazine, but they are not diseased hero since the nror'uction of such effects 
by occasional injections is "unlikely" although "conceivable" (379). 



231 

plan" (620). However, he said thorazine would not be a suitable drug if quick 
results were needid (647). Dr. Cole said that neither at Andros nor at Boston 
.State Hospital would thorazine be given to a non-psychotic child who was acting 
out violently <34i, 372, 3.3). 

While thorazine may be given to a child who is on ongoing anti-psychotic 
medication, the mere fact that he is would not automatically warrant a PRN 
order for thorazine, in Dr. Cole's view (348). Good medical practice and the 
Joint Commission on Hospital Accreditation would require that such an order 
be part of a treatment plan which clearly indicates why the PRN order is given 
(349, 585). Dr. Cole stated that in the case and medical records contained in 
Exhibits 7-3, 7-5, 7-24, 7-26, 4-5, 4-22, 4-25 and 4-52 which he reviewed, there 
was no adequate explanation for issuing the PRN orders for thorazine and no 
justification of PRN medication as part of any treatment plan (346, 359, 360). 
I >r. Kaufman made the same statement about the files he had reviewed ( 585, 586, 
589). None of the case files in the "7" series and none of the medical records in 
the "4" series set forth any justification whatsoever for the PRN orders and 
defendants offered none at trial. 

Indeed, neither of defendants' expert witnesses offered any justification for 
the practice of obtaining PRN orers for intramuscular use of thorazine for every 
boy at Goshen. Dr. Estrada sai dlthat thorabine is only one of three types of 
medication used at his school (807), which has psychotic youngsters as part of 
its regular population ('<85). Dr. Estrada did not mention the use of PRN orders 
and it can be inferred from his testimony that they are not used since he said 
that if a child goes out of control a child psychiatrist is called immediately and 
a determination is made if medication is necessary ( 794) . 

The fact that the children are delinquents, in and of itself, in no way justifies 
the practice of obtaining the PRN orders since the nature of a crime committed 
and diagnosis bear almost no relationship (348). Furthermore, it is not even 
acceptable medical practice to have PRN orders for all children of any diagnostic- 
category in any institution, whether it be a training school or a psychiatric hos- 
pital (347). 

Not only does Goshen routinely obtain PRN orders for intramuscular use ot 
thorazine for all of its children, it obtains them by telephone from a doctor who 
has never personally examined the child (Stipulation, 3/22/74, 1130). Dr. Cole 
stated that such a practice is not acceptable by current medical standards (350) 
and Dr. Kaufman was extremely critical of this as well (5S4). Current medical 
standards require a physician to examine a child, decide that there is a specific 
medical condition which would respond to the medication and then sign an order 
for its use (352). As indicated above, the order must be part of a treatment plan 
which explains why it has been given (358). Dr. Cole also indicated that current 
medical standards would not sanction the authorization by phone of an injection 
of thorazine on the basis of a nurse's description to a physician of violent be- 
havior (351). He said the staff must ride through a period of disturbed behavior 
in such a situation in an understanding and interactive manner (351). Dr. 
Kalogerakis also testified that a basic medical precaution is not to use a medica- 
tion with an unknown patient or with a patient in whom the affect is not known 
(623, 624). Although Dr. Kalogerakis said that thorazine might be preferable to 
other drugs for control of a violent patient, "you really have to know your 
patient" ((523). It is obvious that this cannot be done by telephone. 

Dr. Cole said that PRN orders should be reviewed between every week and 
every month (355) since they should relate to the condition of the patient and 
that condition cannot he assumed to remain constant over time (356). Dr. Kauf- 
man said that in the beginning of a treatment program a careful review ought 
to be made at least every week to determine if the order should be left outstand- 
ing (589). However, Dr. Cole and Dr. Kaufman repeated their views that giving 
an injection of thorazine to a non-psychotic person is poor practice (356) and 
that doing so after a timely renewal of the authorization is no better practice 
(5S9). Even if a child is on on-going anti-psychotic medication, a renewal of a 
PRN order for thorazine is warranted only if his behavior is highly unstable 
(358) and there should be some statement in the record as to why the order is 
being renewed (589). Dr. Kaufman would not approve a renewal of a PRN order 
unless the person was acutely paranoid, delusional and hallucinating, out of 
control and refusing oral medication (590). 

Although all exhibits in the "4" series show that PRN orders for intra- 
muscular use of thorazine are carried on the boys' records for the duration of 
their stay at Goshen, injections are often given under PRN orders which have 



232 

been renewed less frequently than once a month, which is the outside limit set by 
Dr. Cole (355). Examples of this laxity are contained in Exhibits 4-1, 4-3, 4-5, 
4-6, 4-7, 4-9 (order 4y 2 months old), 4-14, 4-22, 4-23 (order 3 x /2 months old), 
4-32,4-35,4-39,4-51. 

The following exhibits indicate other eases in which renewals of the PRN 
order were not made within the period of one month, although no injections 
were actually administered under a particular renewal order : 4-1, 4-3, 4-4, 4-6, 
4-7, 4-8, 4-9, 4-10, 4-12, 4-13, 4-15, 4-16, 4-18, 4-19, 4-20, 4-21, 4-23, 4-24, 4-27, 
4-28, 4-31, 4-36, 4-38, 4-42, 4-44 and 4-56. 

A final group of exhibits shows PRN orders for thorazine carried throughout 
a boy's stay at Goshen despite the fact that it was never deemed necessary to 
administer a shot to the boy. These include : 4-4, 4-10, 4-11, 4-12, 4-13, 4-15, 4-16, 
4-17, 4-19, 4-20, 4-21, 4-22, 4-27, 4-29, 4-36, 4-46, 4-48, and 4-56. (Exhibits 
4-18, 4-24, 4-25, 4-30, 4-31, 4-50 which fall into this category show that renewal 
orders were entered in the boys' records while they were on home visits!) 
Dr. Kaufman said that these renewals were inappropriate (590). 

In addition to improper use of thorazine and of the PRN order generally, 
defendants have also abused thorazine in numerous specific instances by using 
it in a punitive manner. For example, Jeffrey B. was given a shot of thorazine 
for being "nasty concerning washing-up" (Ex. 1-42A). On the following day he 
was again given a shot for refusal to clean his room and shower (Ex. 1-42B). 
Renia A. was given a shot for being profane and belligerent when told his door 
was going to be locked (Ex. 1-142A). See also exhibits 1-110, 1-110A, 1-110B. 

Other youngsters have been given injections because they were "noisy", 
profane, throwing furniture around the isolation room or banging on the door. 
For example, James Z., during the fourth consecutive day of isolation was 
"making noise like a dog" and pounding on the walls. He was given a shot to 
quiet him (ex. 1-33A). Other examples of the use of thorazine injections for 
such reasons are included in the following exhibits : 1-31A, 1-34A, 1-75B, 1-81B, 
1-82B, 1-1 02D, 1-103D, 1-14 ID, 1-151, 1-1 53 A, 1-174D, 1-177B. The use of 
thorazine in the instances reflected in Exhibits 1-33A, 1— 42A, 1-75A and 1-81 B 
were specifically commented upon by Dr. Cole as not consonant with current 
standards of the medical profession (363-365). Dr. Kaufman specifically said 
that the use of thorazine in Exhibit 1-141C was not in conformance with such 
standards either (591). 

In other instances the institution has provoked children into violent behavior 
by placing them in isolation rooms and then giving them an injection of thorazine 
"for their own protection." For example. Exhibit 1-158E describes an incident 
between John K. and a supervisor in which the supervisor pulled the bedding 
off of John's bed because his room did not meet the supervisor's standards of 
neatness. After refusing to put his room back in order, John was taken to Wing I 
where he refused to "stand" and was consequently put into an isolation room 
(Ex. 1-158F). After being put into the room he started to stuff th<> ' eddi^g down 
the toilet and "to scratch his poison ivy to make his arms bleed" (Ex. 1-158B). 
The boy calmed down but 4 hours later started to scream, kick the door, bang 
the furniture and make verbal threats about harming himself. Exhibit 1-15SG 
says he was given medication for his own protection. 

Exhibit 4-33 shows that the medication was an intramuscular injection of 
thorazine. Dr. Cole, who had reviewed this boy's case and medical records, 
stated that this was an inappropriate use of thorazine. Whether or not it was a 
real suicide threat neither isolation nor thorazine were useful. In his opinion, 
someone should have been with the boy (369). Other examples of this type of 
provocation are contained in Exhibits 1-149A (a situation which Dr. Kaufman 
commented upon as creating a very high risk of producing an epileptic seizure 
(360)), 1-33, 1-11, 1^8C, 1-64, 1-83C, 1-89A, 1-93, 1-111A, 1-130A, 1-152, 
1-157, 1-1 76B. 

Dr. Curtis stated that should be obvious in these situations : if a child begins 
to yell and pound on the door of an isolation room he should be released rather 
than be given a shot (203). Dr. Kalogerakis himself described releasing a 
patient from an isolation room within five minutes because he was banging on 
the door (608). 

The staff has also provoked children into violence in other ways and then 
used that violence as justification for administering a shot of thorazine. For 
example, Gilbert D. became "violent" when told to go to "detention" for having 
been uncooperative with staff the previous evening. He was given an injection 



233 

so that staff could restrain him "without re-injuring" his broken leg (Ex. l-l 4 ?)- 
Another example is David F., who failed to have his "conduct memo" signed 
and was scheduled to be placed in "detention" one afternoon. When the time 
came to go to Wing I he became "nasty" and "hostile" but finally went to Wing I 
with staff. However, there he became "highly agitated", made threats to hurt 
someone, and said he could not stay in the room. Exhibit 1-1-J9A notes that 
since he is an epileptic and was on verge of losing control he was given a shot 
of thorazine (4-22). 

Other examples include Exhibits 1-1 (see p. 174 of trial transcript for Dr. 
Curtis' statement that boy was provoked), 1-77A, 1-85B, 1-113A, 1-144A, 1-175 
and 7-20. Dr. Kaufman specifically stated that the use of thorazine in the 
incident described in Exhibit 7-20 was inappropriate (502). 

Despite occasional self-serving statements in the records that thorazine was 
given for the child's own protection, the inevitable impression made by a reading 
of the exhibits enumerated in this section is that the staff perceive it and use 
it as a punitive device. This is confirmed by the testimony of George Kesick to 
the effect that while confined to a room on Wing I he was threatened that he 
would receive a shot of thorazine if he did not stop knocking (115). George 
testified that he is afraid of "getting a needle" (120). Dr. Curtis confirmed that 
most children are afraid of needles (204). 

Dr. Cole stated that the pattern he saw in all of the Goshen records lie reviewed 
was that an interaction between a boy and a staff member, thorazine would be 
used as a way of setting limits (364). In his professional view, drugs should 
only be used for treatment, not for behavior control (366, 367), and that setting 
limits on undesirable behavior should be done by people (369). Dr. Kalogerakis 
agreed that no medication should be used punitively (644). 

Other instances of abusive or negligent use of thorazine include the following. 
Injections of thorazine have been given in the absence of a PRN authorization 
for it (Exhibit 4-2). Dr. Cole and Dr. Kaufman indicated that such action does 
not conform with current medical standards (346. 585). An injection of 50 
milligrams of thorazine was given under a PRN order authorizing 25 milligrams 
only (Ex. 4— 49) . Dr. Cole called this negligent practice (350 ) . 

An excellent ex.imple of how PRN orders are issued automatically and without 
consideration appears in Exhibit 4-50. This shows that a boy was admitted to 
Goshen on August 7, 1973, suffering from orthostatic hypotension as a result of 
the thorazine which had been administered 24 hours earlier. A verbal order for 
a PRN order for thorazine intramuscularly was entered on the hoy's record on 
the same date, with the caveat not to give any that day. Dr. Cole testified that 
such an order was not consonant with current medical standards and that an 
evaluation of the boy should first have been made after he had recovered from the 
earlier medicaton (370. 371). 

Dr. Curtis stated that tr inpiilizing medication should never be forced on a 
non-psychotic youngster. In his opinion, a child would feel as if he were being 
aggressively overpowered and feel humiliated by being wrestled down, having his 
pants pulled down and an injection administered against his will. Dr. Curtis said 
this would he a harmful experience and would tend to nullify treatment efforts 
by the staff since the child would perceive it as mistreatment (203). 

Even in those instances in which medication ought to be used, however, Dr. 
Cole. Dr. Kaufman and Dr. Estrada agreed that it should he given by injection 
only when the patient has been offered the opportunity to take it orally and 
rejected it (352, 586, 805, 803). They also agreed that given a choice between 
taking medication orally or by injection, most patients will choose to take it orally 
(385, 594-10, 806). 

If an injection of thorazine is given, Dr. Cole said that it is necessary to take 
the child's blood pressure at half-bur intervals for two hours and to watch for 
shock (3-"»9). In Dr. Kaufman's opinion, blood pressure should be taken at 15 
minute intervals for several hours (590). Also, in hot weather the child's temper- 
ature should he taken as thorazine can interfere with body heat regulation (359). 
Dr. Estrada stated that children at his school are checked during the hour 
following the administration of medication to see if there are any problems (808 | . 
Dr. Kaufman said it would be "very dangerous" not to check a person who has 
received an injection of thorazine for several hours (591). There is evidence, 
however, that medical checks are not routinely made at Goshen.^ Exhibits 1-1B, 
1-lfiB, 1-77 and 1-77D, 1-136B. 1-151 and 1-151B, 1-152 and 1-152A, 1-158D are 
examples of this negligent treatment of the boys. 



234 
Part 3 — Criminal Justice Abuses 



NATIONAL INSTITUTE OF MENTAL HEALTH 



Development and 

Legal Regulation 

of Coercive Behavior 

Modification Techniques 

With Offenders 

National Clearinghouse for Mental Health Information 



235 

CRIME AND DELINQUENCY ISSUES: 

A Monograph Series 

Development and 

Legal Regulation 

of Coercive Behavior 

Modification Techniques 

With Offenders 



by 
Ralph K. Schwitzgebel, Ed.D., J.D. 

Harvard University 



National Institute of Mental Health 
Center for Studies of Crime and Delinquency 

5454 Wisconsin Avenue 
Chevy Chase, Maryland 20015 



February 1971 



236 



This monograph is one of a series on current issues and directions 
in the area of crime and delinquency. The series is being spon- 
sored by the Center for Studies of Crime and Delinquency, Na- 
tional Institute of Mental Health, to encourage the exchange of 
views on issues and to promote in-depth analyses and development 
of insights and recommendations pertaining to them. 

This monograph was written by a recognized authority in the sub- 
ject matter field under contract number NIH-69-1122 from the 
National Institute of Mental Health. The opinions expressed here- 
in are the views of the author and do not necessarily reflect the 
official position of the National Institute of Mental Health or the 
Department of Health, Education, and Welfare. 



Public Health Service Publication No. 2067 



237 



Foreword 

While experimental psychologists have for several decades been 
concerned with laboratory research pertaining to theories and 
principles of learning, it has been primarily in the past two 
decades that a sophisticated technology of learning and behavior 
change has begun to be applied to a wide range of clinical, 
educational, and many other situations. Since such studies typi- 
cally are reported in specialized scientific and professional jour- 
nals,- the information is not readily and widely available to the 
broader audience which might be interested in such develop- 
ments and their possible applications. 

In this monograph, Dr. Ralph Schwitzgebel provides informa- 
tion about behavior change technologies of relevance to the 
treatment and handling of offenders. Not only does the author 
provide a description of the major behavior modification techni- 
ques which have been developed or are in process of being tested 
and refined, but he also discusses some of the legislative, ad- 
ministrative, and judicial approaches concerning the regulation 
of the above technologies. 

The aforementioned developments and some related electronic 
innovations raise a number of legal, constitutional, and broad 
social policy questions concerning their use. It is interesting to 
note that many of these social policy questions have been present 
in reference to several of our traditional and longstanding meth- 
ods for the handling of delinquents and offenders, viz., involuntary 
programs of treatment, correction, and rehabilitation. However, 
the basic issues appear to have been sharpened and made more 
visible because of increasing concerns about the rights of in- 
dividuals subjected to coercive treatment, and also because the 
power and effectiveness of behavior change techniques have been 
markedly increased. There is a common assumption, indeed often 
a complaint, that technological innovations typically bring about 
and even force a variety of changes in the social order of a cul- 
ture. It has also been said that technology is the scientific tail 
which often wags the social dog. Quite typically, however, the 
larger effects and consequences of technological developments are 
not often adequately anticipated nor are they carefully studied 



• •• 

111 



238 



prior to their utilization. Thus, social policy guidelines to regulate 
and control the uses of such innovations are not usually developed 
in advance of their applications. 

Widely available information about the nature and potential 
uses of technological innovations, and open discussion of their 
value, limitations, and potential problems and consequences, ap- 
pears to be one of the most effective wavs to prevent misunder- 
standing about and misuse of such developments. 

Dr. Schwitzgebel, whose academic training includes the fields 
of psychology and law, and who is also a part-time inventor, 
is very knowledgeable regarding potential applications of elec- 
tronic and related innovations to various social situations. He 
has written extensively on this topic, and is also alert to the 
possible misuses of such knowledge. He notes, for example, that 
while much crime could be technologically prevented, procedures 
would have to be developed for the effective regulation of the 
use of such equipment to avoid political coercion by governments. 

If this monograph helps to provide a better understanding 
of the possible uses, and limitations, of behavior change tech- 
nologies, and if it helps to stimulate open discussion about the 
social policy issues pertaining to the regulation of such develop- 
ments, then the major purpose underlying this work will indeed 
have been accomplished. 

In order to provide the author full freedom to develop the 
issues pertaining to this area, no detailed specifications were set 
in advance and no substantive or editorial changes have been 
made in the manuscript submitted. The views expressed herein 
are those of the author and do not necessarily reflect the policies 
or position of the National Institute of Mental Health; the Cen- 
ter for Studies of Crime and Delinquency is pleased to make 
this monograph widely available to facilitate discussion of its 
topic. 

Saleem A. Shah, Ph.D., Chief 

Center for Studies of Crime and Delinquency 

National Institute of Mental Health 



IV 



239 



Contents 



Page 

Foreword m 

I. Introduction 1 

II. Behavior Modification Programs and 

Research 5 

A. General Characteristics of Behavior 

Modification Programs 5 

B. Specific Programs and Research 5 

1. Operant Conditioning 6 

2. Classical Conditioning 8 

3. Aversive Suppression 12 

4. Electronic Monitoring and 

Intervention 15 

III. Legal Regulation 22 

A. Statutory Standards 22 

B. Administrative Standards 27 

C. Constitutional Provisions 32 

1. Cruel and Unusual Punishments 32 

2. Due Process 42 

3. Equal Protection 50 

4. Privacy 54 

5. Miscellaneous Provisions 58 

IV. Conclusion . _ 62 

A. Criminal Justice System 62 

B. Behavior Modification Techniques 63 

C. Legal Regulation 65 

V. Appendices 

A. Statutes Related to Sex Offenders 69 

B. Statutes Related to Habitual Offenders 70 

C. Statutes Related to Drug Addicts 72 

D. Parole Rules (N. R. Arluke) 74 

References 76 



240 



Acknowledgments 

Mr. Raymond D. Cotton, General Counsel's Office, Public Health 
Service, DHEW, and Professor Paul A. Freund, Harvard Law 
School, provided comments and suggestions related to several 
aspects of this paper. Their help is very much appreciated. 

The Department of Social Relations and the Computing Center, 
Harvard University, also generously allowed the use of their 
facilities. 



VI 



241 



I. Introduction 



Within the past few years there has been a rapid growth in the 
experimental study and application of behavior modification tech- 
niques derived from the principles of learning and technology. 
These techniques, which have been used primarily in clinical and 
experimental settings thus far, create the potential for major 
changes in the area of corrections. It may be helpful to com- 
pare briefly these techniques with other techniques that have 
been used historically to modify the behavior of offenders. 

The use of coercive techniques to deter or change the behavior 
of offenders has a long history of social and legal approval in 
Western civilization, including the United States. The care and 
treatment of offenders in the early American colonies had certain 
medieval overtones. Punishment was often viewed as a form of 
"enforced penance." For example, although branding on the fore- 
head or hand was a frequent form of punishment, the most 
common penalty for "immorality" was to stand the offender on 
the gallows for an hour or two on lecture day with the hang- 
man's rope around his neck and then whip him. 1 Profane tongues 
were treated more directly by squeezing them in a cleft stick 
for as long as an hour while the offender was standing with 
his neck and arms held in a pillory. 

Quakers were particularly troublesome to the political leaders 
in Massachusetts. A statute of 1657 prohibited their entry into 
the colony, and provided that for the first offense a male Quaker 
could have one ear cut off. 2 If he entered the colony a second 
time, the other ear could be cut off. If he then entered a third 
time, the statute required that his tongue be burned through 
with a hot iron. In several early American colonies, the death 
penalty was used not only for murder but also for offenses such 
as rape, witchcraft, and blasphemy. 

Perhaps these penalties were not much more punitive than 
those used in the rest of Western civilization at that time. 
They were, however, as far as can be ascertained, rather mechani- 
cally applied to the offenders with little concern for the suffering 
they produced. Erickson 3 has suggested a reason for this : "It 
was God, not the magistrates, who had sentenced the offender 



83-303 O - 77 



242 



to everlasting suffering, and if the magistrates lashed a few 
stripes on his back or printed his skin with a hot iron, they were 
only doing what God, in His infinite wisdom, had already decreed. 
In a sense, then, the punishment of culprits was not only a 
handy method for protecting the public peace; it was an act of 
fealty to God." 

In 1764, Beccaria published his now famous political treatise, 
An Essay on Crimes and Punishments. It opposed the use of 
the death penalty not so much out of compassion as out of a 
realization that the penalty was not the most effective method 
of deterring others from crime. "The death of a criminal is a 
terrible but momentary spectacle, and therefore a less efficacious 
method of deterring others than the continued example of a man 
deprived of his liberty, condemned, as a beast of burden, to 
repair, by his labour, the injury he has done to society." 4 This 
essay had a major impact upon public thinking and was generally 
viewed as "humanitarian" in its outlook. 

When the States began to build large prisons in the early 
1800's, many of those offenders who would ordinarily have been 
executed or mutilated were often placed in isolation or assigned 
to hard labor. 5 Corporal punishment was frequently used because, 
as the well-known sociologist de Tocqueville noted, "It effects the 
immediate submission of the delinquent; his labor is not inter- 
rupted a single instant; the chastisement is painful, but not 
injurious to health; finally, it is believed that no other punish- 
ment would produce the same effects." e 

One of the most commonly accepted forms of treatment at 
this time, in addition to hard labor, was enforced silence or 
what was more commonly called "solitude." Several beneficial 
effects were assumed to result by not permitting prisoners to 
talk to each other in addition to facilitating the maintenance of 
order in the prison. It was believed that whenever prisoners 
associated with one another, it was those prisoners who were the 
most troublesome who would influence those who were less 
troublesome. By not allowing communication, this "mutual pol- 
lution" could be avoided. Furthermore, solitude would promote 
meditation and repentance. According to opinion in the early 
nineteenth century: "Thrown into solitude, he reflects. Placed 
alone, in view of his crime, he learns to hate it; and if his soul 
be not yet surfeited with crime, and thus have lost all taste for 
anything better, it is in solitude, where remorse will come to 
assail him." 7 

Solitude was sometimes accompanied by confinement away 
from other prisoners. Writing in 1822, the Society for Preventing 
Pauperism in New York suggested that, "Six months solitary 



243 



confinement, in a cell, would leave a deeper remembrance of 
horror on the mind of the culprit, and inspire more dread, and 
prove a greater safeguard against crime, than 10 years imprison- 
ment in our penitentiaries, as they are now managed ... To 
felons, whose minds should be broken on the rack and wheel, 
instead of their bodies, and who can only have their obstinate 
and guilty principles crushed and destroyed by severe treatment, 
no kind of labor should be given . . . [S]olitude, complete and 
entire solitude, should be left to do its effectual work." 8 

One of the early "experiments" in silence and isolation was 
conducted under direction of the New York State Legislature in 
1821. Eighty prisoners were placed in continual solitary con- 
finement on Christmas Day, 1821. During the following year 
five of the prisoners died, one attempted to escape, only acciden- 
tally avoiding death from a fall of four galleries, and at least 
one became insane. So many others became extremely depressed 
that the Governor of the State pardoned and released 26 of them 
and the others were allowed to leave their cells during the day 
to work in the common workshop of the prison. Even among 
those prisoners who survived the confinement and were released, 
the results were disappointing. At least 12 of them were returned 
in a short time for new offenses. One committed burglary the 
first night of his release, and the warden reported "not one 
instance of reformation." 9 

Following these results, the use of solitude gradually dimin- 
ished in use and silence is now seldom required except in large 
dining halls. Today the emphasis is much more likely to be 
placed on encouraging the prisoner to communicate with relatives 
and to discuss his problems with a counselor or in group therapy 
with other offenders, if these facilities are available. This re- 
markable change from silence to discussion seems to have re- 
sulted at least in part from the recognition that the earlier 
method did not effectively change the behavior of prisoners after 
they were released. This enlarged perspective, which looks 
beyond imprisonment to the offender's subsequent behavior in the 
community, has occasioned the re-examination of many cor- 
rectional practices to determine if they are in fact "correctional" 
or only temporarily beneficial or expedient. 

Just as silence was discovered not always to be an effective 
treatment procedure, so also some doubt is now being raised 
about verbally oriented treatment as it is customarily practiced 
with offenders. Some studies have shown no greater reduction 
in the behavior problems of offenders receiving verbally oriented 
treatment than that found for offenders not receiving treatment. 
Failures have been noted for group counseling in prison, 10 group 



244 



counseling outside of prison, 11 and individual counseling. 12 In some 
studies, the group receiving the treatment has shown even more 
maladaptive behavior, 13 psychoneurotic symptoms, 14 or recidi- 
vism 15 than the control group not receiving the treatment. 

The general picture is not promising. In a review of 100 out- 
come reports on correctional programs, Baily 16 reported that those 
studies based upon rigorous research designs usually showed sta- 
tistically nonsignificant improvement, no change, or a worsening 
in regard to the outcome criteria used by the study. It is these 
often disappointing results that have led, at least in part, to 
an increased emphasis on treatment procedures derived from 
certain principles of learning theory. These procedures are usu- 
ally developed in psychology laboratories on a small scale and 
then applied to institutionalized or outpatient populations. 



245 



II. Behavior Modification Programs and Research 

A. General Characteristics of Behavior Modification Programs 

A major characteristic of behavior modification programs is 
their emphasis upon overt behaviors and the systematic manip- 
ulation of the environment to change these behaviors. 17 Some 
of the techniques that can be included within the category of 
behavior modification are operant and classical conditioning, 
aversive suppression, and electronic monitoring and intervention. 
These techniques are only a few of many behavior modification 
techniques that may also include imitation, progressive relaxa- 
tion, and sensitivity training. The techniques discussed in the 
following sections are those that are now playing an increasingly 
important role in the clinical and experimental treatment of 
offenders. 

Behavior modification, as a separate area of study, began to 
emerge clearly in the early 1950's. Its direction as a new disci- 
pline is still not clear. The emphasis upon the treatment of overt 
behaviors and the measurement of observable events in the pa- 
tient's environment gives the discipline a great heuristic value 
over some of the more traditional, psychoanalytically oriented 
treatment procedures. 18 Its theoretical bases are, however, still in 
the process of being formulated. 

Although behavior modification procedures are often oriented 
toward operant or classical conditioning theories, they are not 
necessarily so oriented and there is much diversity. Regardless 
of orientation, the basic underlying theory usually involves care- 
fully specified changes in the environment of the person whose 
behavior is to be changed. A procedure for changing behavior 
that relies upon unique, nontransferrable characteristics of a 
therapist or change agent lies outside of the domain of scientific 
behavior modification. 

B. Specific Programs and Research 

The following programs and related research are briefly de- 
scribed to give a general purview of behavior modification studies 
that have been completed or those that are now being conducted. 



246 



The studies that have been selected are those that are generally 
related to present or potential treatment programs for offenders. 

1. Operant Conditioning 

In operant conditioning studies, a reinforcer (popularly called 
a "reward") is given to a subject after he produces the required 
behavior once or several times. In terms of operant conditioning, 
it is said that the reinforcer is made contingent upon the emission 
of the correct response. This response is known as an operant. 
If the response is not emitted by the individual, no reinforcer 
is given. In a sense, the person must voluntarily "operate" upon 
his environment to receive reinforcement. A reinforcer such as 
food, money, or time out from a task is known to be a reinforcer 
when it increases the rate, or changes the form of the behavior it 
follows. One of the most familiar examples of operant condi- 
tioning at the infrahuman level is the early work of B. F. 
Skinner in which he trained pigeons to peck at lights for many 
hours at a time to receive small pellets of food. 19 

Although a detailed discussion of operant conditioning theory 
is beyond the scope of this paper, it might be noted that except 
for some specialized procedures for shaping behavior, reinforcers 
are seldom given for each correct response. 20 Rather, intermittent 
reinforcement is given. A fixed ratio schedule provides a rein- 
forcer after the operant response has occurred a specified number 
of times. A fixed interval schedule provides a reinforcer for the 
first response occurring after a specified period of time following 
the preceding reinforcement. There may also be variable-ratio, 
variable-interval, and mixed ratio-interval schedules of consider- 
ate complexity. 21 

Different types of schedules produce varying patterns of be- 
havior. As Skinner notes: 

The efficacy of such schedules [variable ratio] in 
generating high rates has long been known to proprie- 
tors of gambling establishments. Slot machines, roulette 
wheels, dice cages, horse races, and so on pay off on a 
schedule of variable-ratio reinforcement . . . The path- 
ological gambler exemplifies the result. Like the pigeon 
with its five responses per second for many hours, he is 
the victim of an unpredictable contingency of reinforce- 
ment. The long-term net gain or loss is almost irrelevant 
in accounting for the effectiveness of this schedule. 22 

The scheduling of reinforcers to increase the probability of 
socially desirable behaviors of offenders is generally accomplished 
in one of two ways. One method involves reinforcing a desired 



247 



behavior, such as cooperation, in such a way that it competes 
with an undesirable behavior, such as fighting. The second method 
involves reducing the reinforcement usually obtained by the 
person as a consequence of his deviant behavior. This is based 
upon the assumption that deviant as well as normal behaviors 
are produced and maintained by their reinforcing consequences. 
Both of these operant conditioning approaches to deviant be- 
havior require structuring the environment so that the reinforcers 
received by the person are carefully specified and controlled. 
Programs that control reinforcers in this manner are sometimes 
known as contingency management programs. 23 

In the project CASE II (Contingencies Applicable for Special 
Education), conducted at the National Training School for Boys, 
delinquent boys' could obtain points for successfully completing 
specified amounts of educational material. 24 These boys lived in a 
specially constructed environment on the schoolgrounds which 
for the first 3 to 5 days included a small but attractive private 
room and exceptionally good meals. Following this, points had 
to be earned by the boy in order to pay for his private room 
and good meals. In addition, he could use these points, some- 
times converted into tokens or small amounts of money, to pay 
for such things as snacks, office study space, private tutoring, 
magazines, telephone calls, or articles from a mail-order catalog. 
Conversely, if a student did not successfully complete his educa- 
tional tasks, he was known as a "relief" student and would lose 
his private room and would have to have his meals served on a 
metal tray after the other students had eaten. Also, he would 
not be able to wear street clothing, attend movies, or take trips 
outside. 

Under these conditions of contingency management, most of 
the students showed very great increases in the level of their 
academic performance and there were marked decreases in the 
number of behavioral problems as compared with the regular 
training school population. These were the primary goals of the 
project. The effect of this type of program on the recidivism of 
these students when they return to the community is not yet 
known. 

It may be noted that the CASE II project used secondary 
reinforcers such as points or tokens which could later be turned 
in by the boys to purchase primary reinforcers such as food 
or a trip out of the institution. This permits the immediate 
reinforcement of behavior in situations when the use of primary 
reinforcers would be difficult or impossible. Although the use of 
these secondary reinforcers can be helpful in modifying the be- 
havior of institutionalized youths, 25 even greater potential may 



248 



lie in their use in community settings. The Behavioral Research 
Project in Tucson, Ariz. 26 utilized community-trained teachers, 
parents, or other adults in the child's natural environment to 
use reinforcers to modify delinquent or predelinquent behavior, 
such as stealing, property destruction, and truancy, following 
the principles of contingency management. An intervention plan 
for each child was designed and the child was given notes, points, 
or a mark on a chart which could be exchanged later for primary 
reinforcers. Behaviors such as prompt arrival at school or obedi- 
ence to instructions were reinforced, as well as periods in which 
a particular undesirable behavior did not occur, e.g., a recess 
completed without a fist fight. Marked improvements in behavior 
were recorded. Similar token economies have been used to improve 
the academic and job performance of male and female high 
school dropouts. 27 It is also likely that the reinforcement proce- 
dures that have been used to modify a wide range of neurotic and 
schizophrenic symptoms might also be used to modify some types 
of delinquent behavior. 28 Community oriented programs are still, 
however, at a very rudimentary level. 

One rapidly emerging area of research in operant condition- 
ing should perhaps be mentioned before discussing classical con- 
ditioning programs. It is the operant conditioning of responses 
which have been traditionally associated with the autonomic 
nervous system. Some studies, though not all, have been able to 
operantly change human skin potential, 29 heart rate, 30 and saliva- 
tion. 31 Animal studies have an advantage over human studies in 
that the animals can be temporarily paralyzed by curare to re- 
move artifacts caused by movement. Under these conditions, 
animals have been taught to increase or decrease heart rate, 
intestinal contractions, stomach contractions, urine formation, 
and electrical brain waves. 32 Either direct electrical stimulation 
of the brain or escape from mild electrical shock has been used 
as a primary reinforcer. In some instances, clear and extreme 
physiological changes can be produced using this process. Some 
success has also been obtained in training epileptic patients to 
suppress abnormal paroxysmal spikes in their electroencephalo- 
grams. 33 As Miller notes, "While it is far too early to promise 
any cures, it certainly will be worthwhile to investigate 
thoroughly the therapeutic possibilities of improved instrumental 
training techniques." 34 

2. Classical Conditioning 

Another type of conditioning frequently used to change behavior 
is classical conditioning as demonstrated by the work of Ivan 
Pavlov. 35 If a stimulus such as food or an electric shock is pre- 

8 



249 



sented to a person, it can generally elicit an involuntary re- 
sponse (or "reflex") such as salivation or muscle contraction. 
This eliciting stimulus is called the unconditioned stimulus. In a 
typical classical conditioning experiment, a neutral stimulus such 
as a bell is presented to the person and this stimulus is followed 
shortly (from a few tenths of a second to 3 or 4 seconds) by 
the presentation of the unconditioned stimulus and the response. 
Sometimes the neutral stimulus and the unconditioned stimulus 
overlap each other briefly. When these stimuli are repeatedly 
paired with each other in this manner, the neutral stimulus 
eventually becomes able to elicit the response even when the 
unconditioned stimulus is no longer present. The neutral stimulus 
is then labeled a conditioned stimulus and the response is known 
as a conditioned response. 

In Pavlov's early experiments, dogs were presented with the 
sound of a metronome followed by meat powder until the pre- 
sentation of the sound alone elicited salivation. 36 Similar condi- 
tioning procedures have been used with humans to produce sali- 
vation as a conditioned response. 

Two central concepts in classical conditioning are excitation 
and inhibition. Excitation, in most general terms, was used by 
Pavlov to refer to the gradual irradiation or spread of impulses 
over the cerebral cortex. Thus, if a conditioned response is 
elicited by a tone of 500 cycles per second, a tone of 400 cycles 
might also elicit the same or similar conditioned response. Op- 
posed to this process were various types of inhibition that produce 
a diminution of response strength to all stimuli. For example, 
a conditioned response which is initially elicited by both 500 
and 490 cycle tones will become restricted to one of them — the 
500 cycle tone — if the 490 cycle tone is repeatedly presented 
without being followed by the unconditioned stimulus, while the 
500 cycle tone remains paired with the unconditioned stimulus. 37 
This process is known as differential inhibition. 

These concepts of excitation and inhibition have been recently 
integrated into a theory suggesting that each stimulus produces 
a generalization gradient. The gradients thus produced interact 
with each other in a mathematically predictable manner to 
produce the observed conditioned response. 38 Classical conditioning 
procedures have been used to modify salivation, heart rate, blood 
pressure, urination, respiration, excretion of bile, infantile suck- 
ing, eyelid movement, and many other responses usually, but not 
always, associated with the autonomic nervous system. 

Classical conditioning procedures have been used primarily with 
two major categories of offenders — alcoholics and homosexuals. 
The central objective is to produce an unpleasant reaction in the 



250 



patient to alcohol or to homosexual activity. In the case of 
alcoholism, the patient is given an emetic such as emetine hy- 
drochloride (the unconditioned stimulus) and just before the 
onset of nausea he is required to look at, smell, or taste the 
alcohol (the conditioned stimulus). 39 The results of this procedure 
appear to be as effective as the usual psychotherapeutic ap- 
proaches. Vallance, 40 for example, found that approximately 5 per- 
cent or fewer alcoholics treated by standard psychotherapeutic 
methods in the psychiatric unit of a general hospital could be 
considered abstinent over a 2-year follow-up period. In contrast, 
one of the highest rates of abstinence was reported in a study 
by Lemere and Voegtlin 41 in which 51 percent of 4,096 patients 
treated by conditioning procedures were found abstinent for 2 
to 5 years following treatment. These studies represent extremes 
and more typical studies show a range of abstinence between 10 
and 35 percent over a period of 1 year or longer. Because of a 
wide diversity in the criteria used to determine abstinence or 
improvement, it is difficult to compare the results of different 
treatment methods reliably. 

Other unconditioned stimuli have been used with alcoholics in 
addition to emetics. One of the most extreme is succinylcholine 
chloride, or its derivatives, a curare-like drug that rapidly pro- 
duces complete paralysis of the skeletal muscles, including those 
which control respiration. Just as the patient is about to drink 
the alcohol, paralysis occurs, producing great fright about being 
unable to breathe and a fear of suffocation. Without danger, 
resuscitation is provided for the patient within 30 seconds or 
less. The results, however, are not clearly better than with 
emetics. 42 

Although electric shock was reported to have been used as an 
unconditioned stimulus in the treatment of alcoholism as long 
ago as 1930, 43 it is only in recent years that it has gained some 
preference in use over emetics. One major advantage is that 
its onset and duration can be precisely controlled. The procedure 
generally used is the same as that described earlier with emetics. 
Because of the high degree of control of administration of elec- 
tric shock, it is possible to pair the termination or avoidance of 
the shock with the sight or smell of a nonalcoholic substance, 
thus perhaps associating the nonalcoholic substance with reduced 
anxiety or relaxation. Tentatively, however, this relaxation- 

89 It should be noted that if nausea follows the drinking: of the alcohol rather than the 
sight or smell of it which precedes the drinking of it, the procedure is more nearly punish- 
ment or aversive suppression than classical conditioning. Aversive suppression will be dis- 
cussed in the following section of this paper. In many studies, classical conditioning and 
aversive suppression procedures are confused or not clearly specified. See Franks, C. M. 
Conditioning and Conditioned Aversion Therapies in the Treatment of the Alcoholic. Inter- 
national Journal of the Addictions, 1 :61-98, 1966. 

10 



251 



aversion procedure does not appear to be significantly better 
than the more standard aversion techniques. 44 

The procedures used in the treatment of alcoholism have 
also been used in substantially the same form in the treatment 
of sexual disorders, particularly homosexuality. The underlying 
assumption is that, except for very basic physiological responses, 
sexual behavior is learned. As Kinsey and his associates have 
noted, "The variations which exist in adult sexual behavior prob- 
ably depend more upon conditioning than upon variations in 
the gross anatomy or physiology of the sexual mechanisms." 45 
Traditionally, behavior modification techniques have attempted 
to pair the stimulus that elicits the homosexual behavior, e.g., 
a picture of a nude male, with an aversive stimulus such as an 
electric shock or nausea. 46 

Although electric shock was experimentally studied as early 
as 1935 in the treatment of homosexuality, it is only in more 
recent years that electric shock has been used clinically. In its 
simplest form, the treatment requires the presentation of pictures 
of attractive males or other homosexually-oriented stimuli which 
are immediately followed by an electric shock. 47 More complex 
procedures sometimes utilize pictures of attractive females or 
other nonhomosexual stimuli at the termination of the homo- 
sexual stimuli. 48 

Similar conditioning procedures employing aversive stimuli 
have also been used to treat transvestism, 19 fetishism,™ and 
sadism. 51 Within the past few years, behavioral treatment strat- 
egies have begun to emphasize not only the negative conditioning 
of the stimuli giving rise to the sexually deviant behavior, but 
also the positive conditioning of sexual responses to heterosexual 
stimuli. In one study, homosexual stimuli were paired with nausea 
and then later the patient was given an injection of testosterone 
propionate to produce sexual arousal and was encouraged to 
masturbate while looking at pictures of females. 52 A similar proce- 
dure has been used to reduce voyeurism ™ and sadistic fantasies. 54 

To the extent that male homosexual behavior is produced not 
so much by an attraction toward males as by a fear of females, 
as suggested by Freudian psychodynamic theory, homosexual be- 
havior might be reduced by eliminating the patient's fear or 
anxiety of heterosexual behavior. This is sometimes accomplished 
by systematic desensitization, a procedure that uses relaxation 
to reduce the anxiety associated with heterosexual stimuli. 55 The 
patient is relaxed and then heterosexual images of gradually 
increasing anxiety are presented to be "counter-conditioned." 
Systematic desensitization may also be combined with the aver- 
sive conditioning procedures as described above. 56 

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Some very preliminary research has been done using classical 
conditioning procedures in the treatment of other behaviors such 
as drug addiction, 57 gasoline sniffing, 58 check writing, 59 and shop- 
lifting. 60 It is likely that the tentative success of these condition- 
ing procedures will lead to the further application of this general 
methodology to other types of offenses. 

3. Aversive Suppression 

The aversive suppression of Dehavior corresponds in common 
usage with the concept of punishment. But the term "punish- 
ment" as it is ordinarily used has several conflicting meanings 
when examined from the viewpoint of learning theory. Most 
customarily, punishment refers to the presentation of an aver- 
sive stimulus after the person has emitted the behavior which 
is to be reduced in frequency or eliminated. Thus, the child is 
slapped on the hand (aversive stimulation) after he has reached 
into the cookie jar or even after he has started to eat the cookie. 

Another type of punishment which is often used consists of 
the removal of positively reinforcing stimuli following the be- 
havior to be eliminated. For example, after the child has reached 
into the cookie jar, his mother may take the cookie away and 
may also prevent him from playing with his toys. These two 
possible types of punishment, while recognized, 61 have not been 
given any generally accepted labels. Burgess and Akers have 
suggested that "Those stimuli whose presentation will weaken 
an operant's [behavior's] future occurrence are called punishers; 
the process, positive punishment . . . Those stimuli whose re- 
moval will weaken an operant's future occurrence are called pos- 
itive reinforcers; the process, negative punishment." 62 The terms 
"positive punishment" and "negative punishment" are not widely 
used, but they do point out the distinction between the presenta- 
tion of aversive stimuli and the withdrawal of positive stimuli 
following the prohibited behavior. It is the scientific application 
of aversive stimuli that is of primary concern here as it raises 
more acutely certain legal and ethical problems than does the 
withdrawal of positive stimuli which has had much broader 
public use and acceptance. 63 

The application of aversive stimuli following the prohibited 
behavior is surely not new. Whippings, mutilations, and duck- 
ings in cold water have had a long history of use. A rather novel 
form of treatment was once reported by the famous 18th century 



81 "In solving the problem of punishment we simply ask : What is the effect of withdrawing 
a positive reinforcer or presenting a negative? . . . [I]nsofar as we are able to give a 
scientific definition of a lay term, these two possibilities appear to constitute the field of 
punishment." Skinner, B. F. Science and Human Behavior. New York: Macmillan, 1956, p. 
185. 

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physician and patriot, Benjamin Rush, in which a drug addict 
was successfully cured by having an artificial snake pop out of 
her opium box. Although such a treatment now seems quite out of 
style, it does have the virtue of pairing the aversive stimulus 
closely in time with the behavior to be suppressed. In fact, if there 
is a series of behaviors leading to the final, prohibited behavior, 
punishment may be most effectively used if the aversive stimulus 
is applied following one of the behaviors in the series prior to 
the final behavior. 64 This is rarely the situation in the administra- 
tion of criminal justice. Punishment is rarely administered prior 
to the offense and more generally occurs several hours to several 
jrears following the prohibited behavior. The typical delinquent 
may steal several cars before being apprehended and the applica- 
tion of aversive stimuli or the withdrawal of positive stimuli 
begins. 65 

If it were not for the rather humiliating and painful aspects 
of public whipping, the failure of this treatment to produce long- 
lasting changes in offenders' behavior would be a rather amusing 
illustration of correctional ineffectiveness. In a study of the 
whipping penalty in Delaware, Caldwell found that 1,302 of- 
fenders were whipped between the years of 1900 and 1942 in- 
clusive. 66 In a special study of the criminal careers of 320 prisoners 
who were whipped, 61.9 percent were again convicted of some 
crime after their first whipping. Of course, it might be argued 
that not enough whipping was administered to be effective. The 
data collected by Caldwell do not bear this out. Of those offenders 
who were whipped twice, 65.1 percent were again convicted of a 
subsequent offense. Also, in a comparison study of whipped and 
unwhipped offenders, 68.5 percent of those whipped were later 
convicted of crimes, 61.1 percent of those offenders who were 
imprisoned instead of whipped were later convicted, and only 
37.5 percent of those offenders placed on probation instead of 
whipped were later convicted. From a learning theory viewpoint, 



44 The application of the aversive stimulus to one of the behaviors in a series of behaviors 
may be effective because the punished behavior, or a stimulus closely associated with it, 
comes to serve as a signal of potential, aversive stimulation, thus producing avoidance 
responses rather than the prohibited behavior. See Dinsmoor, J. A., Punishment: I. The 
Avoidance Hypothesis. Psychological Review, 61:34—46, 1954. Dinsmoor, J. A., Punish- 
ment: An Interpretation of Empirical Findings. Psychological Review, 62:95-105, 1955. See 
also Bandura, A., and Walters, R. H. Social Learning and Personality Development. New 
York: Holt, Rinehart and Winston, 1963, pp. 182-186. 

60 "In addition to the fact that delayed punishment may affect the wrong behavior, delay 
is also ineffective because it increases the possibility for the undesirable response to be 
reinforced in some way. We can see this fact, too, in the criminal's case. If capture is not 
immediate, then there is indeed a good chance that the act of breaking a law will be 
immediately reinforced. No matter what the long-range consequences turn out to be, from 
the criminal's point of view the fact may still remain that sticking a gun in someone's 
face was followed by the acquisition of money; ergo, armed robbery 'obviously' works, the 
problem being not to get caught later." Lawson, R., Learning and Behavior. New York: 
Macmillan, 1960, pp. 281-282. 

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whipping could be expected to be ineffective for a number of 
reasons, one of them being the delay between the prohibited 
act and the subsequent punishment, as previously mentioned. 67 

Behavioral modification techniques closely pair the prohibited 
behavior, or precursors of it, with the subsequent aversive stim- 
uli. Considerable experimentation of this nature has been con- 
ducted in the past few years with sexually deviant persons. In 
one well known early study of the treatment of transvestism, the 
patient received painful electric shocks on his feet from a grid on 
which he was standing while dressing in women's clothes. 68 Over a 
period of 8 days, the patient received a total of 200 shocks during 
the frequent treatment sessions. A follow-up study 14 months 
later indicated only one subsequent relapse of crossdressing by 
this patient. 69 

The use of aversive stimuli in the suppression of homosexual 
behavior or other deviant sexual behavior has been reported in 
over 26 studies. 70 These studies, generally using electric shock or 
an emetic to induce vomiting, often do not clearly distinguish 
between classical conditioning procedures and aversive suppres- 
sion procedures. The studies tend to show an effectiveness in 
changing behavior which is at least equal to or better than the 
traditional, psychoanalytic treatment of these disorders. Greater 
attention, however, needs to be given to the design of these treat- 
ment methods to incorporate learning theory paradigms to as- 
sess more accurately their therapeutic potential. 71 

Temporary paralysis and apnea have been used in the treat- 
ment of chronic alcoholics. Clancy, Vanderhoof , and Campbell 72 
reported using the following treatment procedure after the pa- 
tients were informed that they would have "some difficulty in 
breathing." A hypodermic needle was inserted in the patient's 
arm vein and a saline drip attached. When the drip was running 
and an injection of succinylcholine chloride prepared, a small 
amount of the patient's favorite alcoholic beverage was poured 
into a glass in front of him. A few seconds after the patient 
tasted the alcohol, apnea occurred and the patient, fearful of suf- 
focating, was ventilated with a breathing bag. A 1-year follow-up 
study by these researchers, as well as a study by other researchers 
using a similar procedure closer to classical conditioning, 73 showed 
somewhat positive results in producing abstinence. These re- 
searchers, however, are cautious in advising the use of apneic 
paralysis except for a carefully selected population, and even then 
the subsequent anxiety or other side effects may make the pro- 
cedure inadvisable. 



67 Although whipping is now seldom used, it is still permissible under Delaware statutes. 
Del. Code Ann. tit. 11 sees. 3907, 3908 (Supp. 1968). 

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Some preliminary research has been done in the use of apomor- 
phine, an emetic, in the treatment of drug addiction. In a study 
by Liberman, two hospitalized narcotic addicts were made nau- 
seous following a "fix" with morphine by the administration of 
apomorphine during 38 treatment sessions conducted over a pe- 
riod of 5 weeks. 74 "Booster" sessions were also used at varying in- 
tervals when the patients began to notice a recurrence of craving 
for morphine. Tentatively, the procedure appears to be useful in 
reducing the craving for narcotics although considerable social 
assistance and perhaps outpatient therapy may be needed in addi- 
tion to this treatment to avoid subsequent dependence. 

The above study by Liberman also provided occasional, free- 
choice situations in which the patient could choose between mor- 
phine and a pleasant social situation with the therapist and nurse. 
This illustrates the application of some experimental studies sug- 
gesting that the development of appropriate, alternative responses 
during the period of suppression induced by punishment is 
helpful in preventing high rates of recurrence of the punished 
behavior. 75 

There are additional findings from laboratory studies that gen- 
erally have not yet been included in the design of treatment 
programs utilizing the aversive suppression of behavior. For ex- 
ample, the suppression of behaviors that are based upon an inner 
drive or upon the avoidance of other aversive stimuli may yield 
different patterns of suppression. 76 Also, unless the stimuli are 
very intense, aversive suppression generally does not completely 
eliminate the occurrence of the punished behavior but rather 
lowers its rate, which may gradually, without additional suppres- 
sion, return to its approximate prepunishment rate. There are 
also occasional "paradoxical" effects of punishment in which the 
use of aversive stimuli may increase the rate of the punished 
behavior when the aversive stimuli are removed. 77 Finally, pun- 
ishment may produce side effects such as anxiety or deception 
which ultimately make the behavior increase. Nevertheless, there 
is considerable agreement that the appropriate application of 
aversive stimuli can at best, for short periods of time, markedly 
alter the rate or pattern of expression of the punished behavior. 

4. Electronic Monitoring and Intervention 

Within the past few years there has been an increasing rec- 
ognition that some changes in behavior can be produced better 
by treatment which is conducted in the offender's natural en- 
vironment than by treatment conducted within an institution. 
One manifestation of this is the rapid increase in the use of 
work-release programs, preparole community service programs, 

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and halfway houses. Therapy techniques are also being modified 
with the understanding that some reinforcers that maintain ap- 
propriate behavior in an institution may not be the same rein- 
forcers that maintain appropriate behavior in the community. 

Ultimately, most offenders will have to live in an environment 
similar to the one that produced, or at least did not successfully 
inhibit, their illegal behaviors. Two approaches are possible. The 
therapist may be able to help the offender deal with these en- 
vironmental stimuli by introducing them into treatment sessions 
while the offender is still institutionalized or by extending treat- 
ment procedures into a community setting in which the offender 
lives during a temporary or conditional release from the institu- 
tion. 

Although some environmental stimuli that are the precursors 
of illegal behavior, such as new cars or potential victims, ob- 
viously cannot be brought easily into treatment sessions, photo- 
graphs or films of them can be used. For example, a film of 
women pushing perambulators was presented to a patient with 
this fetish just prior to the onset of chemically induced nau- 
sea. 78 Similarly, a picture of the roommate of a homosexual pa- 
tient, or a film of shoplifting in one of the shoplifter's favorite 
stores can be used in treatment. 79 Of course, some stimuli such as 
alcohol or bank checks can be brought easily into treatment ses- 
sions. 80 

However, even though some stimuli can be brought into the 
treatment session, a problem still remains. The stimulus removed 
from its customary context may appear much different from usual 
to the patient and therefore may not elicit his typical response. 
For this reason, increasing emphasis has been placed on the in 
vivo treatment of behavioral disorders, particularly the phobias. 
For example, a patient who is fearful of flying may be relaxed 
either chemically or by verbal instructions and then gradually 
introduced to flying by being accompanied by the therapist to 
the airport. 81 Subsequently, the therapist may accompany the 
patient on short, trial flights. Similarly, a patient with homo- 
sexual tendencies can be treated by an emetic in an office setting 
and then he can self-administer the emetic in the community 
when his impulses may lead to homosexual behavior. 82 This type 
of in vivo treatment has an additional advantage over typical 
institutional or office treatment. The successes achieved by the 
patient, though perhaps initially small, are likely to seem more 
"real" to him than changes that occur within an institution. 
These changes may encourage more effort by him for further 
change. Also, the environmental changes produced by the patient's 
effort may reinforce new patterns of behavior. 

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The treatment of the institutionalized offender in the commu- 
nity, however, presents the problems of a potential escape and 
increased risk to the community. One approach to this problem 
has been the development, in prototype form, of small personally 
worn transmitters that permit the continual monitoring of the 
geographical location of parolees. 83 This system, which also in- 
volves the use of intensive treatment and the help of volunteers 
in the community, is known as an electronic rehabilitation sys- 
tem. 

As presently designed the electronic rehabilitation 
system is capable of monitoring the geographical loca- 
tion of a subject in an urban setting up to 24 hours. 
The subject wears two small units approximately 6 in- 
ches by 3 inches by 1 inch in size, weighing about 2 
pounds. As the wearer walks through a prescribed moni- 
tored area, his transmitter activates various repeater sta- 
tions which retransmit his signal, with a special location 
code, to the base station. The repeater stations are so lo- 
cated that at least one is always activated by the wear- 
er's transmitter. 

This prototype system as now used extends only a few 
blocks during street use and covers the inside of one 
large building. The primary purpose of this system is to 
demonstrate the feasibility of larger, more complete sys- 
tems and gather some preliminary data. Through the 
use of carefully placed repeater stations in each block, 
the system is theoretically duplicable such that large geo- 
graphical areas may be covered with a large number of 
subjects each transmitting a unique signal. The range 
of the system and the specificity with which a person 
can be located depend largely upon the number of re- 
peater stations used. 84 

The impetus for the use of electronic intervention in the treat- 
ment of offenders emerges from several sources. There has been 
a rapid increase in the use of telemetry for medical purposes 85 
and a shift in the budget allocations of the electronic industry 
from defense research and development projects to feasibility 
studies in the public sector. 86 In addition, there has been a marked 
increase in the research and development of law enforcement 
technology. Some of this research has been aimed at facilitating 
surveillance through the use of specially equipped helicopters, 87 
computerized information retrieval systems, 88 and infrared sen- 
sors. 89 

Considerable effort is also being devoted to the development of 



83-303 O - 77 - 19 



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systems for the rapid, electronic location of objects in an urban 
setting. Many of these systems are being developed primarily for 
monitoring the location of motor vehicles such as buses or police 
cars. One presently operative system provides the location of a 
vehicle every 5 seconds within a limited urban area with an 
accuracy of approximately one block. 90 The Institute of Public Ad- 
ministration has indicated the feasibility of developing a broad- 
scale vehicle locator service within 2 years. In a report prepared 
for the Office of Urban Transportation of the U.S. Department of 
Housing and Urban Development, the organization notes, "Anoth- 
er, secretive, law enforcement use of AVM [Automatic Vehicle 
Monitor] systems would be in 'bugging' suspect vehicles, valuable 
shipments, etc. ; movement could be traced through the city with- 
out a conspicuous 'tail'. Future refinement of the craft may make 
it possible to implant a transponder on a subject's person — in 
his shoe, for instance." 91 

Special security equipment has been designed and is being 
further developed to prevent the removal or compromise of per- 
sonally worn equipment by parolees. 92 If this equipment were used 
to guarantee the wearing of personal transmitters and integrated 
into an electronic locator system, a very powerful, involuntary 
surveillance system would be possible. All of the major compo- 
nents of such a system have been developed in a design or proto- 
type stage in various laboratories. The complete, involuntary 
system has not yet been used; but as described earlier, a volun- 
tary, prototype system covering a few city blocks has been 
studied. 93 

Another potential source for the introduction of location moni- 
toring systems into the public domain may be citizen protection. 
Citizens might be equipped with transmitters to alert the police 
in the event of attack. Crewe suggests : 

It is at least conceivable that citizens could be licensed 
to carry miniaturized police call systems in the form 
of a small radio transmitter. This could relay a cry for 
help to transmitters on the corners of each block. This 
signal could be automatically and instantaneously trans- 
mitted to the local police who could immediately dis- 
patch assistance. It would be relatively simple to design 
into such a communications system the necessary safe- 
guards against tampering and abuse. For example, the 
pocket transmitter should be capable of being turned on 
but not of being turned off. This would prevent the 
criminal from interrupting the signal. With modern elec- 
tronic systems such a transmitter could be very small, 

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making it difficult to detect and in any case the signal 
would be inaudible. As regards abuse, it would be possi- 
ble to license the use of such transmitters thereby re- 
stricting their use to those who do not abuse the privi- 
lege of carrying it. It should perhaps be pointed out that 
it would be entirely unnecessary for the whole popula- 
tion to carry such transmitters. In fact, this problem is 
something like the problem of vaccination against small- 
pox, that is, it only requires a certain percentage of the 
population to be innoculated to eradicate the disease. 94 

In addition to monitoring the location of a person, other 
characteristics might also be monitored. Equipment has been de- 
veloped for monitoring voice, 95 blood pressure, 96 physiological ac- 
tivity, 97 and electroencephalograms. 98 Sophistication of design in 
instrumentation is making the implantation of sensors less neces- 
sary, 99 but unless transmission is by hard wire, telemetry is still 
generally limited to a short range of a few hundred feet or within 
one or two buildings. Capabilities are, however, rapidly expand- 
ing. 

As previously noted, many components of potentially effective 
monitoring and intervention systems usable with offenders have 
been developed in various laboratories but have not yet been 
often integrated into operable systems. For example, devices- have 
been developed for measuring penile erection during the thera- 
peutic treatment of sexual deviates or for the objective measure- 
ment of sexual preferences. These devices have generally recorded 
changes either by using a plethysmograph 10 ° or a strain gauge. 101 
Transducers have been designed that provide an electrical out- 
put suitable for the continuous monitoring and recording of 
penile changes. 102 The linkage of these transducers to a portable 
transmitter rather than to a recorder would not be difficult and 
could, when included within an electronic locator system, provide 
the capability of precisely monitoring sex offenders within the 
community. 

Thus far in the present discussion, the emphasis has been upon 
the acquisition of data about the offender. A complete communica- 
tion system could also permit the transmission of signals to the 
offender within the community. These signals could transmit in- 
formation to the offender or activate equipment worn by him or 
near to him. To date, there has been no extensive use of portable 
equipment in behavior modification. There are, however, a few 
notable exceptions. A small, portable shock apparatus with elec- 
trodes attached to the wrist has been used to help inhibit a 
patient's addiction to Demerol (Pethidine). 103 The patient in this 

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study applied electric shocks to himself when he felt strong im- 
pulses to take the drug. The researcher, Joseph Wolpe, known 
for several innovations in psychotherapy, observed, "A strong 
and frequent endogenous impulse for Demerol was markedly di- 
minished, apparently as a consequence of its being reciprocally 
inhibited by strong faradic stimulation of the forearm of the 
patient. Though only nine shocks were given in relation to the 
endogenous craving — all in the course of 1 week (the shocks in 
the following 2 weeks having been in relation to exogenous stim- 
uli) — the decrease in its strength and frequency was such that the 
patient was easily able to abstain from the drug for a 3-month 
period during which no further shocks were administered." 104 

Powell and Azrin have developed a cigarette case that consists 
of a shock device and counter that are activated each time the 
case is opened. 105 Portable devices that produce a regular, rhythmic 
beat have been developed to be worn behind the ear 106 or on the 
wrist to reduce stuttering. 107 A portable device has also been de- 
veloped that emits a tone signal when a patient assumes a faulty 
posture known as "round shoulders" for a period of at least 3 
seconds. 108 Similarly, a personally worn device has been developed 
for delivering small amounts of direct current to the forehead of 
patients to reduce depresson. 109 Gradually, a new field of study 
may be emerging, variously known as behavioral engineering or 
behavioral instrumentation, that focuses upon the use of electro- 
mechanical devices for the modification of behavior. 110 

One of the most controversial areas of behavioral instrumenta- 
tion is that of intracranial stimulation. Some of the early studies 
of the intracranial stimulation of the human brain began approxi- 
mately 15 years ago. 111 Techniques that originally allowed the 
implantation of electrodes for only a few days or a few weeks 
have now been developed to permit the positioning of the elec- 
trodes for periods up to 3 years. 112 This research has generally been 
conducted for medical purposes to gain a better understanding of 
brain function or to alleviate severe behavioral impairments, 113 or 
modify human emotions. 114 

Relatively little research has been done in the area of remote 
communication with patients, but there are some exceptions. For 
example, to help control the restlessness of a 10-year-old boy in 
a classroom, a therapist transmitted a tone signal to him through 
an earphone whenever the boy sat quietly long enough to earn 
a piece of candy. 115 Similarly, devices have been used for transmit- 
ting comments or instructions to parents 116 or psychology train- 
ees 117 during therapy sessions. In the treatment of alcoholics, a 
distant observer has used a walkie-talkie type transmitter to de- 
liver electric shocks to patients at appropriate moments in the 

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treatment procedure. 118 Tone signals have also been transmitted to 
persons over a location monitoring system, previously described, 
to reduce crime-related behaviors. 119 Using this system, a person 
with a problem of aggression following heavy drinking was con- 
ditioned in a laboratory to experience nausea when he was served 
alcohol following the presentation of a particular tone signal. 
Later, this tone signal was transmitted to him in barrooms in a 
high crime rate area to reduce his drinking behavior. 

The standard bellboy paging system has been used to help 
patients reduce their rate of smoking. 120 Tone signals were trans- 
mitted to the patients in their homes or offices that permitted 
them to smoke. Smoking at other times was forbidden. The num- 
ber of transmitted tone signals was gradually reduced over a 
period of several weeks. An experimentor has also transmitted a 
signal to a delinquent which was received and displayed 
to the delinquent as a small light or as a "tap" from a vibra- 
tactile unit within the belt. This system was used to operantly 
condition appropriate behavior in the classroom. 121 

Another example is a recently developed two-way communica- 
tion system used to transmit the electrocardiographic signals of 
cardiac patients from a moving ambulance to a hospital where a 
physician makes an interpretation of the signals. 122 Directions are 
then transmitted back to the ambulance personnel to initiate, 
in emergency situations, resuscitative procedures such as electri- 
cal defibrillation. A more behaviorally oriented feedback system 
is that of intracerebral telemetry which involves both the remote 
electroencephalographic recording of brain wave patterns and the 
remote brain stimulation of human subjects. 123 Although this has 
been accomplished only over a short distance within a building, 
Delgado et al. have suggested : 

The combination of both stimulation and EEG re- 
cording by radio telemetry offers a new tool for two-way 
clinical exploration of the brain and it may be predicted 
that in the near future microminiaturization and more 
refined methodology will permit the construction of in- 
struments without batteries and small enough to be per- 
manently implanted underneath the patient's skin for 
transdermal reception and transmission of signals 
through several channels. 124 
As can be seen, new developments in monitoring and inter- 
vention systems are occurring rapidly and are greatly increasing 
communication capabilities within the offender's natural environ- 
ment. Within the near future, electronic technology is likely to 
become a very important factor in the design of programs for 
the modification of the behavior of offenders. 

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III. Legal Regulation 

A. Statutory Standards 

To help determine the standards of practice for the treatment 
of offenders within the criminal justice system, major statutes 
related to sex offenders, habitual criminals, and drug addicts were 
examined in all 50 States and the District of Columbia. These three 
categories of offenders were chosen because they present a wide 
range of significant policy issues that must be resolved in the 
daily operation of the criminal justice system. The statutes were 
examined in the latest official codes and supplements available as 
of September 1, 1969, ranging in date of enforcement for the 
various States from 1967 to 1969 inclusive. The following discus- 
sion presents briefly some of the data obtained from these statutes 
and the statistical analysis of this data. 

In the present study, 31 States and the District of Co- 
lumbia had statutes specifically related to sex offenders as a cate- 
gory of persons. 125 These statutes include those that require com- 
pulsory registration by persons convicted of sex offenses as well 
as the more typical sex offender statutes permitting special penal- 
ties or treatments for this category of offenders. The distinction 
between civil and criminal statutes was not always clear and was 
sometimes a matter of arbitrary decision. The present study used 
the location of the statute in the State code and the type of com- 
mitment procedures as the primary criteria determinative of the 
civil or criminal nature of the statutes. Under these criteria, 18 
States (56.3 percent) had criminally oriented sex offender stat- 
utes. Fourteen States (43.7 percent) had civilly oriented sex 
offender statutes. 126 

The statutory definitions of a sex offender varied widely among 
the States. Seven States (21.9 percent) used a definition of a sex 
offender that required at least a sexual act as an element of the 
definition and dangerousness or harmfulness to others. 127 Seven 
States (21.9 percent) required a propensity or impulse toward 

125 See Appendix A for a listing of these statutes. 

m Hereinafter the District of Columbia is included within the terms "State" and "States" 
unless otherwise specified. 

127 Includes statutes using phrases such as "course of misconduct in sexual matters" 
(Neb. Rev. Stat. «ec. 29-2901 [1964]) or other terms indicating the requirement of 
evidence of a prior, legally prohibited sexual act. 

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sexual acts and mental abnormality, illness, or instability. The 
remaining States (56.2 percent) tended to combine in various 
patterns the elements of sexual behavior or impulses, mental ab- 
normality, and dangerousness. 

Nine States (28.1 percent) mentioned a disparity between the 
age of the victim (usually 16 years of age or younger) and the 
age of the offender (usually an adult or over 16 years of age) as 
an element in the definition of the offender. 

Six States (18.8 percent) provide sentences of incarceration 
or treatment for sex offenders that are limited to a fixed period 
of time. The remaining 26 States (81.2 percent) provide in- 
determinate sentences for sex offenders. 128 The criteria underlying 
the standards for release from incarceration or treatment are 
typically quite broad or vague. For example in Pennsylvania the 
sex offender may be released ". . . at such time and under such 
conditions as the interest of justice may dictate." 129 Seven States 
set standards of release that emphasize recovery and/or maxi- 
mum benefit from the sentence. An Alabama statute provides 
that the offender shall remain under treatment "until such per- 
son shall have fully and permanently recovered from such psy- 
chopathy" 13 ° and a Colorado statute stipulates that the offender 
may be released "when maximum benefits have been obtained 
from supervision." 131 In contrast to these treatment-oriented cri- 
teria, there are nine statutes that focus more directly upon the 
probability of future offenses as a standard of release. In Nevada 
the offender must be certified not to be dangerous. 132 Some stat- 
utes combine treatment and probability orientations such as 
the Washington statute that requires the incarceration of the 
offender until in the superintendent's opinion he is "safe to be 
at large, or until he has received the maximum benefit of treat- 
ment" 133 

A comparison of the statutory definitions of sex offenders with 
the criteria for release of sex offenders shows a statistically 
significant relationship between the definition of offenders in 
terms of acts, dangerousness, or mental illness and the criteria of 
release in terms of specified time periods, dangerousness, or 
recovery. 134 Thus, statutes that tended to define sex offenders in 
terms of mental illness also tended to permit release when the 
offender was recovered or had received the maximum benefit 
from his sentence. 



m "Indeterminate" includes here any sentence that may be imposed for the natural life 
of the offender. 

131 Chi square=15.958, 8 df, p<.05; Cramer's V = .499; Lambda (symmetric) =.310. For 
statistical analyses, the Data-Text Program, Preliminary Draft. 1969, Department of Social 
Relations, Harvard University was used. Intercoder reliability was .93. 

23 



264 



Forty-seven States have statutes related to habitual offenders. 135 
Twelve of these States (25.5 percent) require only one offense 
for the application of the statute to the offender. Thirty-five 
States (74.5 percent) require two or more offenses. Nineteen of 
these States (40.4 percent) provide sentences for habitual of- 
fenders that are limited to a fixed period of time. Twenty-eight 
States (59.6 percent) provide indeterminate sentences. Those 
States that require two or more offenses for the application of 
the statute tend also to use more indeterminate sentences than 
those States requiring only one offense. 136 Thirty of the 47 States 
with habitual offender statutes (63.8 percent) expressly per- 
mit the offender to be released on parole during the term of 
his sentence. Release to the community is by action of the pa- 
role board in 42 of the States (89.4 percent) but in five States 
(10.6 percent) release may be by action of the court or other 
organization. 

Forty-two States have statutes specifically related to drug ad- 
dicts or users. 137 Twelve of these States (28.6 percent) have 
statutes that are criminally oriented and 30 (71.4 percent) have 
satutes that are civilly oriented. The definitions of drug addicts 
varied widely among the States. Twenty-seven States (64.3 
percent) appear to focus primarily upon the use, often repeated 
or habitual, of a drug. A Missouri statute defines a drug addict 
as a person who habitually uses narcotic drugs to such an ex- 
tent as to create a tolerance of such drugs and who does not 
have a medical need of such drugs. 138 Nine States (21.4 percent) 
have statutes that more clearly focus upon the harmfulness 
or dangerousness of the use of drugs to the user or others. 
An Illinois statute applies to any person who has lost the power 
of self-control with reference to narcotic drugs and abuses the 
use of drugs to such an extent that the person or society is 
harmed. 139 Six States (14.3 percent) have statutes that variously 
combine these elements of use and dangerousness or that contain 
other elements. In North Dakota, a drug addict is a person who 
because of his illness is likely to injure himself or others if al- 
lowed to remain at liberty or needs care and lacks sufficient capaci- 
ty to make responsible decisions about hospitalization. 140 Six States 
(14.3 percent) have statutes that refer to the self-harm of the 
drug addict as an element of definition, 36 States (85.7 percent) 
do not refer to self-harm as a definitional element. 

Nineteen States (45.2 percent) provide sentences for drug 
addicts that are limited to a fixed period of time. Twenty-three 
States (54.8 percent) provide indeterminate sentences. Of these 



135 See Appendix B for a listing of these statutes. 

136 Chi square = 7.99, 1 df, p<.05; Phi = .413; Lambda (symmetric) =.194. 
UT See Appendix C for a listing of these statutes. 



24 



265 

States, 12 (52.2 percent) allow release of the addict when he is 
cured or no longer addicted. The remaining States allow release 
when the addict has benefited, 141 becomes of sound mind and 
memory, 142 or meets other conditions of an unclear nature. For 
example, the drug addict may be released in North Dakota when 
the "conditions justifying hospitalization no longer exist," 143 and 
the drug addict in Mississippi may be given treatment as long 
as necessary. 144 There is a slight tendency for drug addict statutes 
that are time-limited to define drug offenders in terms of the 
use of the drug whereas statutes that are indeterminate tend to 
define drug offenders as dangerous to themselves or others. 145 

It is clear that the statutes related to sex offenders, habitual 
offenders, and drug addicts vary widely both within and among 
the States. Uniformities in the statutory standards for the treat- 
ment of these offenders are difficult to find. A statistical analysis 
was made to determine whether there were consistences within 
individual States in the manner in which the States deal with 
these three categories of offenders. The results suggest that those 
States that utilize either criminally or civilly oriented statutes in 
the treatment of sex offenders do not similarly utilize criminally 
or civilly oriented statutes in the treatment of habitual offenders 
or drug addicts. Nor do those States that define sex offenders in 
terms of harmfulness or mental abnormality similarly tend to 
define habitual offenders or drug addicts in these terms. Nor is 
use of time limited or indeterminate sentences with sex offenders 
closely associated with the use of time-limited or indeterminate 
sentences with habitual offenders or drug addicts. 

There is, however, one exception to this general pattern of no 
relationship between the types of definition and treatment given 
these three categories of offenders. Among those 24 States that 
have both sex offender and drug addict statutes, there appears to 
be some rough similarity between the criteria used to determine 
the release of these offenders from treatment. 146 Those States that 
emphasize a time limit or lack of dangerousness for the release 
of sex offenders also tend to use the same criteria for the release 
of drug addicts when compared to States that emphasize recovery, 
benefit from treatment, or other criteria of release. Nevertheless, 
in general, there appears to be little similarity in the manner in 
which the States as separate legal units deal with these cate- 
gories of offenders. 

Another potential source of statutory variation in the treat- 
ment standards applicable to offenders lies in the conditions or 
terms of probation and parole. A survey of parole rules by Arluke 



145 Chi square =5.81, 2 df. p<.05; Cramer's V = .381; Lambda (symmetric) =.091. 

146 Chi square=27.09, 12 df, p<.05; Cramer's V = .613; Lambda (symmetric) =.40. 



25 



266 

indicates a wide variation among the States. 147 A few broad 
consistencies can be found. Most States require some notification 
of the parole officer before changes can be made in employment 
or living quarters. Most States also require gainful employment, 
filing of written reports, compliance with the law, support of de- 
pendents, and permission to use a motor vehicle. Most States also 
prohibit undesirable associations and the use of alcohol or nar- 
cotics. 

No single parole rule is common to all of the States. 148 Further- 
more, the similarity of standards is sometimes more apparent 
than real, even when a large percentage of States specify by 
statute a particular condition of parole. In a discussion of liquor 
usage, Arluke notes : 

Oddly, three States (Florida, Idaho, Michigan) have 
moved from "allowed but not to excess" to "prohibited." 
To counterbalance this, three States that had prohibited 
the use of liquor (Kansas, Louisiana, Mississippi) have 
discarded this regulation. Missouri, Virginia, and West 
Virginia previously were the only States with no liquor 
regulation; West Virginia now prohibits usage. Hawaii 
and Alaska have both included liquor usage as "pro- 
hibited." 149 

Some conditions such as requiring permission to travel out of 
the county or a curfew clearly vary among the States. A few 
States have conditions relating to criminal registration, search 
of parolees, gambling, and church attendance. There appears to 
be a slight increase in number of parole conditions specified by 
statute. 150 To the extent that these conditions represent standards 
for administrative action that are likely to be broadly followed 
within the State, they may provide some basis for the judicial 
review of administrative action. 

In summary, the statutory standards for the treatment of 
offenders (sex offenders, habitual offenders, and drug addicts), 
and even the statutory definitions of these offenders, do not ap- 
pear to be generally similar among the States. Only the most 
broad conditions of parole appear to be common among the 
States and consistent over time. There may be a trend toward 
increasing the number of statutory specifications of standards 
within State jurisdiction. 



117 A table of parole rules as prepared by Nat R. Arluke is reproduced in Appendix D. 
Arluke, N. R. A Summary of Parole Rules — Thirteen Years Later. Crime and Delinquency, 
15: 267-274, 1969. 

26 



267 

B. Administrative Standards 

Within the criminal justice system, considerably more empha- 
sis has been placed upon securing the rights of the accused than 
guaranteeing the rights of offenders following the determination 
of guilt or need for treatment. This emphasis, in view of the 
limited resources of the criminal justice system, is perhaps not 
misplaced, for the use of criminal or civil sanctions against an 
innocent person is a grave injustice. Nevertheless, even those 
who have transgressed the laws or customs of our society still 
remain citizens. Most of them will remain in the community on 
probation or, if imprisoned, will eventually be returned to the 
community as participants in the common life of the community. 
No longer is the offender considered, as in the eighteenth cen- 
tury, "a beast of burden, to repair, by his labour, the injury he 
has done to society." 151 Rather, the emphasis is now placed on 
the rehabilitation of the offender through treatment to prevent 
future violations of the law. 

The rehabilitation of offenders must take place, however, with- 
in a system which must also be capable of managing and if neces- 
sary subduing and restraining for the public good the most 
violent and dangerous persons in our society. The correctional sys- 
tems of the various States have developed a very wide range 
of procedures for achieving these objectives and unless abuse. is 
very clear or likely, judicial review and restraint are seldom used. 
In summarizing a study of correctional practices, Wechsler 
concluded, "Nowhere, indeed, in the entire legal system is so 
much discretion vested in the organs of administration as in 
the treatment aspects of the penal law and nowhere have we 
given less attention to the formulation of authoritative standards 
for the exercise of the discretion thus reposed." 152 

As previously indicated, the broad scope of administrative dis- 
cretion may derive not only from the traditional lack of judicial 
review but also from a failure of legislatures to specify clear 
standards for administrative action. For example, the statutory 
standards for the release of sex offenders from treatment are 
not closely related to the civil or criminal nature of the statute 
under which the offenders are committed. 153 Furthermore, the 
standards of release are often quite vague. 

Some additional indication of the wide range of discretion 
exercised by parole officers is found in a study conducted by 
Robison and Takagi of 7,301 parolees released in California 
during 1965. 154 The attitudes of the parole officers in general to- 
ward the types of offenders who should remain in the com- 



153 Chi square=4.52, 4 df, p = .34. 

27 



268 

munity were greater determinants of whether parole would be 
revoked by a parole officer than was the parolee's behavior. Rev- 
ocation rates therefore varied widely from one parole district 
to another. 155 Furthermore, when parole officers were presented 
with 10 hypothetical cases and asked to make recommendations 
regarding whether the parolees should remain on parole or be 
returned to prison, agreement among the parole officers was clear 
in only two of the cases ; the remaining recommendations showed 
a consistency ho greater than that achievable by chance. 156 

The reluctance of courts to review decisions of an administra- 
tive nature made by correctional agencies is sometimes referred 
to as the "hands-ofF ' doctrine as it found expression in Banning 
v. Looney. 157 "Courts are without power to supervise prison 
administration or to interfere with the ordinary prison rules 
or regulations." 158 Although the courts have sometimes considered 
prison administration as a matter beyond their jurisdiction, 159 it 
seems more likely that the reluctance of the courts to intervene 
has been based upon policy reasons, particularly the fear that 
judicial review would subvert the authority of prison officials 
necessary for the maintenance of prison discipline. 160 Whether 
judicial review would in fact lead to the disruption of order in 
prisons or whether it would reduce abuse and prisoner dissatis- 
faction, thus facilitating order in prisons, is an empirical ques- 
tion. Also, the current trend toward more frequent judicial re- 
view of parole administration may suggest that the underlying 
reason for the prior lack of judicial review of prison administra- 
tion was one of policy rather than jurisdiction. 

The courts have shown a gradually increasing willingness to 
review prisoners' petitions regarding their treatment and care. 
As Vogelman has observed : 

During the past 25 years, a number of courts have 
recognized that the "hands-off" doctrine is not a satis- 
factory principle in prisoner litigation, and a trend has 
been noted away from it. Perhaps the leading statement 
indicative of this trend was made in dictum by the 
Court of Appeals for the Sixth Circuit in Coffin v. Reich- 
ard. The court stated: "A prisoner retains all the 



165 The authors suggest, "The results of this study underscore the importance of the parole 
agent and the parole unit supervisor as decision-makers or decision-influencers who contribute 
to variations in rates of return to prison or favorable outcome on parole. This variation 
was found to be more or less independent of variations in the characteristics of parolees. 
Accordingly, these results add to the existing accumulation of data which make inappropriate 
the interpretation that these variations in rates are a primary function of changes in the 
characteristics of parolees." Robison, J., and Takagi, P. Case Decisions in a State Parole 
System. Administrative Abstract No. 31, Research Division Department of Corrections, 
State of California, 1968, iv. See also Takagi, P. and Robison, J. The Parole Violater: An 
Organizational Reject. Journal of Research in Crime and Delinquency, 6:78-86, 1969. 

28 



269 

rights of an ordinary citizen except those expressly, 
or by necessary implication, taken away from him by 
law." 161 

However, even when the courts are available, the prisoners 
can redress wrongs only through specific remedies that carry 
with them certain limitations developed by case law. For exam- 
ple, the writ of habeas corpus was traditionally restricted to 
the challenge of the legality of the imprisonment. A marked 
change occurred, however, in Coffin v. Reichard 162 in 1944. The 
Sixth Circuit court indicated that it would permit the use of 
habeas corpus to inquire into any unlawful interference with 
the personal liberty of the inmate who had suffered "injuries 
and indignities" at the U.S. Public Health Service at Lexington, 
Ky. 163 Prisoners may also seek injunctions, not limited by the 
exhaustion doctrine, to prevent the infringement of their rights 
under the various Federal civil rights acts. 165 Civil and criminal 
penalties are sometimes available under these acts. Prisoners 
may also attempt to bring tort actions under the Federal Tort 
Claims Act 166 or similar State statutes that waive sovereign im- 
munity and they may attempt to utilize a writ of mandamus. 167 

The State or Federal correctional agencies have authority 
delegated to them by the legislatures (or by constitutional 
mandate) to make certain kinds of determinations with broad 
discretion. A wide range of decision-making functions to achieve 
certain objectives is, in the terms of the Administrative Pro- 
cedure Act, "committed to agency discretion by law." 168 Never- 
theless, certain determinations by the agencies may be open to 
judicial review when the administrator of the agency has acted 
beyond the limits of his discretion, has acted arbitrarily without 
discretion, or has violated his statutory duty. Partial judicial re- 
views of certain aspects of agency action not committed to dis- 
cretion are also permitted. 169 There remains, however, a judicial 
reluctance to review which has been particularly marked in re- 
gard to State and Federal correctional agencies. 

Underlying the doctrine of agency discretion as a limitation 
on judicial review there are several policy issues that the courts 
may consider in determining the legislative intent. Saferstein 
has suggested three : 



163 The use of habeas corpus in still limited by the doctrine of exhaustion of State remedies 
for State prisoners attempting to bring cases in Federal courts as expressed in 28 U.S.C. sec. 
2254 (1964). As some writers have pointed out, "[A] prisoner seeking redress from the Fed- 
eral courts faces a dilemma. Because the State courts have followed a 'hands-off' policy in 
the area of prison administration, State intervention is unlikely. If a prisoner chooses not 
to seek review by certiorari, this fact is likely to influence the Federal court not to hear the 
case. If he does seek certiorari, and his petition is denied, Federal review is equally unlike- 
ly." 164 

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270 

First is the interest in fostering the most creative 
and efficient use of limited agency resources. For exam- 
ple, an agency may need a certain freedom of action 
and informality of procedure that may be jeopardized 
by reviewing courts' tendency to facilitate review by 
the judicialization of agency procedure. Second is the 
interest in the most efficient allocation of the resources 
of the Federal courts, potentially threatened by an 
onslaught of requests for review of administrative ac- 
tions. Although these two interests are in effect parts 
of more general interests of the public in the most 
effective, cheapest, and speediest enforcement of congres- 
sional programs, they are considered separately because 
they often conflict with one another in this area. The 
third interest is that of the individuals seriously enough 
affected by the agency's action to have standing to 
challenge its validity. 170 

Quite understandably, courts are reluctant to review adminis- 
trative actions if there are alternative methods of regulating 
agency discretion such as review by legislative committees, if 
much expertise is required to understand agency operation, or if 
the agency's actions are highly integrated into an overall plan. 
Finally, if the legislative delegation of authority to the agency 
is very broad and general, as it often is in regard to correctional 
agencies, 171 the court is left without clear guidelines by which 
to weigh competing factors or develop appropriate remedies. The 
delegation of authority in Federal agencies is seldom invalidated 
even if the standards are vague. Even standards as vague as 
"to eradicate the evils of Communist activity" have been allowed 
by the Supreme Court in considering the refusal of bail to aliens 
by the U.S. Attorney General. 172 State courts have been some- 
what less reluctant to find an invalid delegation when standards 
are not clear. 173 

Although the standards set by the legislature for agency action 
may be vague, some of the problems of this vagueness might be 
cured if clear standards of practice have developed prior to, or 
perhaps even following, the delegation of authority. Viewed na- 
tionally, treatment procedures vary widely from State to State. 
The conditions of parole, for example, differ greatly among the 
States. 174 

The most common parole conditions are prohibitions against 
liquor usage, change of employment or living quarters without 
permission, and undesirable associations or correspondence. 175 



174 See Appendix D. 

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271 

Other conditions involve prohibitions against out-of-county or 
community travel, possession of weapons, or marriage without 
approval. Some States require support of dependents, treatment 
for VD, participation in antinarcotics programs, return to living 
quarters at a specified or reasonable hour, and church attendance. 
A similarly wide range of conditions may attach to the status of 
the probationer. 176 

Nor do the conditions enumerated by statute exhaust the po- 
tential range of conditions, for many statutes allow the court 
to impose additional conditions. Probationers, for example, have 
been required to refrain from making remarks against the 
sheriff, 177 compensate an individual, 178 join the Navy, 179 or write 
an essay, 180 and not have a telephone on the premises. 181 Standards 
of practice, both explicit and implicit, are widely discrepant and 
the doctrine that suggests that consistently applied standards 
can be curative of vagueness in the delegation of authority to 
an administrative agency thus requires special caution in its 
application to correctional agencies. 

Unlike some carefully integrated Federal agencies with well- 
defined and publicly visible policies, State correctional agencies 
are not likely to be as well integrated or consistent. Personnel 
frequently change and there is generally low public visibility ex- 
cept during a crisis, which is not a very appropriate time to 
formulate broadly applicable standards. The court is thus left 
without clear policy guidelines from either the legislature, as de- 
rived from statutes and records of hearings, or the public, as 
derived from customary and generally accepted practice. Without 
expressions of basic policy, procedural safeguards are not likely 
to be adequate as to constitutional rights or the permissible 
scope of the judicial review. 

Finally, it should be asked whether permitting the judicial 
review of administrative action in correctional agencies might 
open the "floodgates" and overwhelm the courts with the com- 
plaints of prisoners. To this possibility, the court in Edwards 
v. Duncan 182 noted that ". . . Where there is no administrative 
provision for an impartial resolution of factual issues under- 
lying such claims, there is no alternative to judicial inquiry, 
even though many, or even most of such claims may be asserted 
irresponsibly." 183 Expanded judicial review appears to be in as- 
cendancy and the "hands-off" doctrine in decline. This may be 
reflected in the 1968 Supreme Court decision in Lee v. Wash- 
ington 184 which found racial discrimination in prisons in viola- 
tion of the fourteenth amendment. To avoid overburdening 
the courts, Justice Friendlv suggested in Cappadora v. Cele- 
brezze, 1 * 5 a case involving the appeal of claims under the Social 

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272 

Security Administration, that the number of appealable claims 
might be regulated by limiting the extent or scope of judicial 
review. 186 Courts could improve their understanding of the institu- 
tional effects of permitting certain types of partial review and 
then adjust their policy accordingly to achieve a suitable balance 
between clear institutional requirements and the interests of 
offenders. 

C. Constitutional Provisions 

As previously noted, the gradual abandonment of the "hands- 
off" doctrine by the courts in regard to the review of adminis- 
trative action has been limited to that necessary to safeguard 
the constitutional rights of offenders. The present section will 
consider some of the constitutional provisions that may set limits 
on the treatment of offenders. Of particular concern will be the 
provisions related to cruel and unusual punishments, due process 
of law, equal protection, and the "penumbral" right of privacy. 
Finally, several less frequently used provisions found in the first, 
fourth, thirteenth, and fourteenth amendments will be briefly 
considered. 

1. Cruel and Unusual Punishments 

In addition to a limitation on excessive bail and fines, the 
eighth amendment of the United States Constitution prohibits 
cruel and unusual punishments. 187 Although the term "cruel" in its 
historical context clearly bars the use of vindictive punishments 
such as torture, disfigurement, and burning, the meaning of the 
term "unusual" is much less certain. The term is often considered 
to be a modifier of "cruel" and thus unusually cruel punishments 
may be prohibited. But a linguistic analysis of the term does 
not seem to provide a very reliable guide to judicial interpreta- 
tion. Bodily injuries and indignities from guards and inmates 
have been prohibited by this constitutional provision. 188 Rather, 
the phrase "cruel and unusual" appears to reflect an underlying 
policy forbidding punishment that is contrary to the contem- 
porary standards of human decency. 189 This policy finds expres- 
sion functionally in prohibiting certain categories of punish- 
ment. 

Various kinds of punishment, such as chaining a prisoner to 
his cell by his neck, 190 may be prohibited. The court may also 
consider the cruelty of various methods of punishment. Thus, 
the Supreme Court found that electrocution as a means of exe- 
cution was not prohibited by the eighth amendment, 191 but be- 



187 "Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual 
punishments inflicted." United State Constitution, eighth amendment. 

32 



273 

heading was prohibited. Also, punishments may be prohibited 
that are disproportionate to the offense. Perhaps the most note- 
worthy case in this regard is Weems v. United States 192 in 
which, for a minor falsification of a public record, the offender 
was sentenced to 15 years of hard and painful labor, the wearing 
of a chain fastened from his wrist to his ankle, and, following 
release, surveillance for life. 

Although the distinctions between method and proportionality 
are not always clear, Sherman 193 has provided a helpful illustra- 
tion: 

A death sentence for rape and murder would not be 
held disproportionate to the offense; however, if the 
sentence were to be carried out by starvation, it would 
no doubt be held an unnecessarily severe infliction of 
a proper penalty and would thus be prohibited. On the 
other hand, a sentence of 20 years at hard labor for a 
Peeping Tom offense is likely to be deemed cruel and 
forbidden because it is disproportionate to the offense. 

Finally, the infliction of any punishment or penalty whatever 
may under some circumstances be viewed as prohibited by the 
eighth amendment. In Robinson v. California, 194 the Supreme 
Court found that a California statute which defined an offense 
as "being addicted to the use of narcotic drugs" violated the 
eighth amendment's cruel and unusual clause. Although inter- 
pretations vary, this decision in light of the later Powell v. 
Texas 195 case appears to prohibit criminal convictions based upon 
mere status without an act. 196 In a sense, Robinson moves toward 
a definition of criminal responsibility and does not go to the 
conditions of care or treatment of persons following conviction. 197 

Even though Robinson does not directly relate the cruel and 
unusual clause to the treatment of offenders, it has had two 
important, indirect consequences. First, it makes quite clear that 
this clause of the eighth amendment is applicable to the States 
through the fourteenth amendment, an assumption that was 
theretofore primarily implicit in the decisions of the Supreme 
Court. Second, Robinson renewed interest in the possible appli- 



198 Mr. Justice Marshall observed in Powell: "The entire thrust of Robinson's interpreta- 
tion of the Cruel and Unusual Punishment Clause is that criminal penalties may be inflicted 
only if the accused has committed some act, has engaged in some behavior, which society has 
an interest in preventing, or perhaps in historical common law terms, has committed some 
actus reus." Powell v. Texas, supra, note 195, p. 533. If, however, Robinson prevents only "pure 
status" offenses, then perhaps a similar result could have been reached in Robinson, on due 
process grounds, thus obviating a confusion : that to permit the punishment of acts associat- 
ed with a status is the same as punishing the status itself. Such an interpretation may go 
too far, because although the ingestion of narcotics may be essential to addiction, appear- 
ance in public while intoxicated may not be an invariable concomitant of alcoholism. There 
may be degrees of association between a status and a proscribed act. 



83-303 O - 77 - 20 



33 



274 

cations of the cruel and unusual clause to the care and treatment 
of offenders. 

Prior to Robinson, the cruel and unusual clause was generally 
considered not a very effective constitutional provision. It appeared 
particularly ineffective following Louisiana ex rel. Francis v. 
Resweber, 198 a case brought before the Supreme Court in 1947. 
The State of Louisiana attempted to electrocute the petitioner 
but the equipment failed. The petitioner claimed that to be 
subjected again to the process of electrocution would be a cruel 
and unusual punishment. Although the Court noted that death 
by installment would not be permitted, the equipment failure 
was an unforeseeable accident and the mental anguish and 
physical pain not worse than that suffered during a fire in a cell 
block. Following Robinson in 1962, however, the cruel and unusual 
clause appeared more viable. Although the clause is frequently 
used (over 200 cases involving the cruel and unusual clause are 
reported in the Seventh Decennial Digest), it is seldom success- 
ful in challenging the care or treatment of offenders. 199 

The cruel and unusual clause applies to "punishments" and this 
term is generally taken to mean criminal punishments. The 
constitutional context of the term in the eighth amendment is 
plainly criminal. Therefore, one often finds more difficulty in 
applying this clause to procedures that are labeled "civil" rather 
than "criminal." 200 For example, although the trend appears to be 
away from the use of sterilization procedures with socially 
troublesome persons, sterilization statutes are more likely to be 
upheld when they appear to be civil rather than criminal in 
nature. 201 But because the distinctions between civil penalties and 
criminal punishments may often not be clear, it would seem 
more useful to look to the general purpose of the statute in 
question rather than its label. 

As to purpose, statutes may permit procedures directed toward 
punishment (or discipline), treatment, or research. Punishment 
may have either retributive or utilitarian purposes. From a 
utilitarian viewpoint, it may facilitate the general deterrence of 
others from crime. Although there may be some question about 
the deterrence effects of certain punishments, this is a policy 
matter that has long been left to the legislatures. 

Treatment, in contrast, is directed toward producing an en- 
during change in the behavior of an individual as he lives under 
natural conditions within the community. Included within the 
concept of treatment is an idea of restoration or improvement 
rather than restriction or disablement. Also intrinsic to treat- 
ment, especially behavior modification, is the requirement of 
measurable results. "Treatment" techniques that do not produce 

34 



275 

measurable results may be either an aspect of research or merely 
ineffective, and therefore probably inappropriate, procedures. 

Punishment, treatment, and research may be subject to dif- 
ferent constitutional limits. Some of the major limitations upon 
punishment as found in the cruel and unusual clause have been 
briefly indicated above. In contrast, there appears to be a ten- 
dency to place fewer or less severe constitutional restrictions on 
treatment than on the punishment or discipline of offenders. Per- 
haps this is because treatment, particularly if it is of an aversive 
nature, may not only serve retribution and deterrence functions 
but may also be viewed as benefiting the offender. This latter 
attribute of "benefit" to the offender, whether he desires such 
benefit or not, seems to broaden considerably administrative 
discretion and at the same time allows the introduction of medical 
metaphors and analogies into the evaluation of the appropriate- 
ness of the treatment techniques. Whether this is desirable in 
terms of policy will be considered below. 

A New York case, In re Spadafora 202 in 1967 upheld a compul- 
sory treatment program for narcotics addicts against constitu- 
tional attack. The court cited Robinson 203 and In re De La O 20i 
and quoted section 200 of the New York Mental Hygiene Law 
stating that "Narcotic addicts alone are estimated to be responsible 
for one-half the crimes committed in the city of New York 
..." 205 The court also noted with unusually vivid language that: 

They [narcotics addicts] require the mandatory life- 
saving aid now offered for the first time by the wise 
enactment of the New York State Legislature under 
the enlightened and dynamic sponsorship of Governor 
Nelson A. Rockefeller, who inspired the favorable re- 
sponse of the community to the compulsory rehabili- 
tation of those who are so unfortunately addicted. The 
enforced separation of narcotic addicts from the general 
population is the only humane and benevolent means to 
succor and rescue these victims from the mire of their 
own mental and physical deterioration, while at the 
same time protecting the bulk of our citizenry from the 
perils of the depredations of those with uncontrolled 
and insatiable need for drugs. 206 

Nearly 2 years later, in 1969, the Supreme Court of New York, 
Washington County, could still facilely attempt to combine the 
dual objectives of community safety and benefit to the drug addict 
in People ex rel. Stutz v. Conboy. 207 The offenders contended that 
their confinement in a correctional institution for the treatment of 
addiction constituted cruel and unusual punishment. In addition to 

35 



276 

detention in the correctional facility, the offenders participated 
in group therapy meetings of approximately li/ 2 hours in length 
scheduled at least three times a week. The court denied the cruel 
and unusual punishment claim and observed that, "It matters not 
that Great Meadows is a correctional institution. Indeed, there is 
testimony that at least 40 inmates, most of them young people, 
are narcotic addicts who, although not certified under Article 9 
[Mental Hygiene Law], partake in the program, voluntarily 
attending the classes regularly. In order for relators to obtain 
the benefits of the program, their liberty must be sacrificed." 208 

But the objectives of community safety and the beneficial treat- 
ment of offenders are not always compatible and this becomes 
disturbingly apparent when the offender refuses treatment or is 
no longer considered treatable. This issue was confronted more 
directly by the 4th Circuit Court of Appeals in Sas v. State of 
Maryland 209 than by the courts in Spadafora or Stutz, though the 
case left the issue perhaps unsatisfactorily resolved. In con- 
sidering the Maryland Defective Delinquent Act that would 
allow the indeterminate confinement of delinquents for treat- 
ment, the court observed, "It is obvious, however, from the 
statistics to date, that the justification for the Act may not 
rest solely or even primarily, on the theory that all defective 
delinquents will receive treatment or that the majority of the 
inmates who do will be greatly benefited or cured by treat- 
ment . . . Many of the inmates will, therefore, in all likelihood, 
be confined for life on the premise that they are untreatable 
or incurable but, nevertheless, too dangerous either to life or to 
property to be released in a free society." 210 Treatment is thus 
confused with preventive detention. 

The techniques of treatment as found in behavior modification 
programs emphasize measurable results and can be clearly dif- 
ferentiated from mere confinement or preventive detention. This 
does not, of course, prevent legislatures from passing statutes 
that specify both treatment and public safety objectives. Most 
States with special sex offender statutes provide indeterminate 
sentences. 211 The criteria for the release of offenders incarcerated 
under these statutes allow very much room for differing judg- 
ments. This greatly increases the probability of confusion in 
the handling of offenders or even abuse because long-term de- 
tention may be carried out under guise of treatment. 212 Although 



21 - An example of linguistic and logical confusion may be found in In re Marks, 453 P. 2d 441, 
453 (Cal. Sup. Ct. 1969) : "Unless the rehabilitation authorities are empowered to act with 
equal swiftness [as parole officers! to remove him [the addict] from the contaminating en- 
vironment and provide him with the necessary physiological and psychological support, the 
timetable of his recovery may be severely set back." But the relevant statute (Welfare and 
Institution Code, sec. 3000) as cited by the court (p. 455) suggests that treatment shall be 
carried out not only for the protection of the addict against himself, "... but also for the 
prevention of contamination of others and the protection of the public." 

36 



277 

behavior modification may at times necessitate confinement, there 
is a clear trend toward providing treatment within the community 
where ultimately new behavior patterns must be established and 
observed if the treatment is to be considered successful. 

It appears that treatment, as separate from mere confinement, 
may, if it is within the customary limits of decency, be imposed 
upon the offender. In Haynes v. Harris 213 the petitioner who 
was serving an indeterminate sentence at the Medical Center 
for Federal Prisoners, Springfield, Mo., contended that medical 
treatment which was forced upon him against his will was cor- 
poral punishment and that it violated the eighth amendment. 
The court found that the facts did not imply "cruel and inhuman" 
punishment and regarded the contention as "obviously without 
merit." 

In Peek v. Ciccone 21 * the court permitted the forceful, intra- 
muscular administration of a tranquilizer to an inmate who was 
diagnosed as a schizophrenic. The extent to which this adminis- 
tration of the drug was for the purpose of long-term rehabilitation 
rather than for the temporary management (discipline) of the 
prisoner is not clear. Treatment, when available, is customarily 
offered to or required of the prisoner without clear procedures for 
obtaining his consent. Rather, there seems to be a presumption 
that the offender will participate in treatment. In Buchanan 
v. State, 215 the Supreme Court of Wisconsin examined the due 
process claims of a sex offender who was incarcerated beyond 
the maximum term that could have been imposed for his crime 
as a person "dangerous to the public." The court commented, 
as dictum, that "The defendant cannot be heard to complain when 
he did not accept the treatment offered." 216 

If an offender may be compelled either directly or indirectly 
by future administrative or legal consequences to participate in 
treatment (and there might be some question about this), it 
would be very important to know the permissible limits of such 
treatment. Surely, the treatment should not offend contemporary 
standards of decency, but the standards of decency as custo- 
marily applied to offenders are far less humanitarian than those 
generally found in voluntary admission institutions. Prisoners 
may be deprived of personal items, placed in solitary confinement, 
and fed a restricted diet. 217 Physical force and sometimes even 
tear gas may be used to control prisoners. 218 A prisoner, however, 
may not be deprived of the fundamental physical needs of personal 
hygiene, warmth, and light. 219 A behavior modification procedure 
that attempted such severe deprivations would not be permitted. 

The torture of prisoners is not permitted 22 ° and the beating 
of prisoners is rapidly becoming unlawful, 221 although public 

37 



278 

whipping as "treatment" might be reluctantly allowed. 222 By anal- 
ogy, treatment techniques that required the administration of 
painful electric shock over a period of time, as used in some 
aversive suppression treatments of transvestism or homosexual- 
ity, 223 would probably require express, voluntary consent from 
the prisoner as well as other procedural safeguards such as 
publicly available records of the treatment. Similarly, as involun- 
tary sterilization becomes increasingly less acceptable as a medi- 
cal technique for offenders, behavior modification methods in- 
volving the implantation of electrodes or sensors will probably 
require higher standards of express, voluntary consent even 
though these physiological alterations, unlike sterilization in 
most instances, may be reversible. Even with consent, and the 
offender's eager participation, there can still be some question 
as to the extent to which offenders may permissibly waive their 
rights. This will be discussed in the following section as an 
aspect of the due process of law. 

Although the conditions of parole and probation vary widely, 
they have seldom been invalidated on eighth amendment grounds. 
In 1936, a California Appellate Court permitted the sterilization 
of a sex offender as a condition of probation. 224 In 1965, the 
Supreme Court declined to review a California decision that 
imposed sterilization as a condition of probation on an offender 
in lieu of his confinement. 225 The offender had failed to support 
his children. With changing standards under the eighth amend- 
ment, these decisions may be of questionable authority, but they 
define the outer limits of permissible conditions. 

The imposition of antinarcotic testing as a condition of parole, 
probation, or "outpatient status" 226 for drug addicts is becoming 
quite common, particularly in California and New York. This, 
testing is generally compulsory and conducted on a periodic and 
surprise basis. It usually involves the injection of a small amount 
of Nalline (nalorphine hydrochloride) under the skin, or a uri- 
nalysis. 227 The Nalline testing involves the measurement of pupil 
size before and after the administration of the Nalline. The 
procedure requires about 30 minutes, is reliable, and the side ef- 
fects range from slight euphoria to nausea. 

These tests can detect the use of narcotics in the absence 



222 BaUer v. State, 195 A2d 757 (Del. Sup. Ct. 1963); Cannon v. State, 196 A. 2d 379 (Del. 
Sup. Ct. 1963). The court has consistently permitted whipping, relying largely on the doc- 
trine of judicial restraint. Whipping could not, however, qualify as treatment as herein de- 
fined because the behavioral results appear to be negative. Supra notes 65, 66. 

2M "[A]lthough the California Rehabilitation Center outpatient is not officially called a pa- 
rolee, the manner and methods of release and the continuing control and supervision of a 
parolee from prison and an outpatient from California Rehabilitation Center are strikingly 
similar . . ." 49 Ops. Cal. Atty. Gen. 11 (1967) cited in In re Marks. 453 P. 2d 441, 451 (Cal. 
Sup. Ct. 1969). 

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279 

of any other evidence. The argument that the revocation of pro- 
bation on this evidence alone would be cruel and unusual 
punishment for a status, based upon an extention of the Robinson 
case, has not been accepted by the courts. In Hacker v. Superior 
Court of Tulare County 228 a positive urine test could be used to 
provide "reasonable or probable cause" for a search of a known 
addict and could be used to help infer his knowledgeable pos- 
session of narcotics serving as a basis for revocation. 

The use of antinarcotic testing to determine the frequency 
of illegal behavior and reduce it, hints at the possible accepta- 
bility of other methods of recording and preventing behaviors 
in the community. Electronic monitoring and tracking devices 
would not seem to be directly prohibited by the cruel and unusual 
clause within a broad view of the issue, 229 and have been used to 
monitor the location of parolees. 230 If, however, the equipment 
was particularly cumbersome, obvious to a casual observer, and 
clearly labelled the wearer in the community as an offender, it 
might be considered a form of "branding" or excessive social 
censure and therefore impermissible. Also, the severe status deg- 
radation resulting from the wearing of such equipment would 
be likely to impair its therapeutic effects and thus the use of 
the equipment could not be considered an aspect of treatment 
but rather of retribution or deterrence. 231 

The Court in Weems v. United States 232 appeared to focus not 
only upon the physical cruelty to be endured by the prisoner while 
incarcerated but also his lifelong social isolation and mental suffer- 
ing while in the community. This suffering was, in the Court's 
view, clearly disproportionate to the offense. The purpose and use 
to which the electronically obtained information would be put, as 
well as its general availability, might help to determine the extent 
to which surveillance was repugnant to the eighth amendment. 
This is closely related to the issue of privacy to be discussed sub- 
sequently. 

Several of the functions that could be performed by electronic 
monitoring and intervention systems are now being carried out 
by parole or probation agents as permissible conditions. Pro- 
bationers may be required to submit to searches of person and 
property. Some States permit the search by statute or adminis- 
trative practice. This will be discussed later in more detail as a 
fourth amendment problem. 

Restrictions on the movement of offenders are common. Pro- 
bationers in most States must request permission to change their 
places of employment or residence and the majority of States also 
require permission for out-of-State travel and the use of an auto- 
mobile. 233 A few courts typically require a brief period of con- 

39 



280 

finement as a condition of probation at the outset of the pro- 
bationary term. 234 Although this may be criticized on policy 
grounds, 235 it has customarily been permitted. Youths may be 
required to report to a "Training Academy" for manual labor 
during the working hours of a weekend, 236 and if the youth is a 
ward of the court, confinement may be permissible during the 
weekends. 237 The Model Penal Code, section 301.1(2) (c), promul- 
gated by the American Law Institute, 238 states that the court 
may require the probationer "to undergo available medical or 
psychiatric treatment and to enter and remain in a specified 
institution, when required for that purpose." Requiring non- 
custodial and perhaps even temporary custodial attendance at 
behavior modification programs that are not unreasonably dis- 
tant from the offender's residence would seem allowable. 

There is presently considerable emphasis upon providing treat- 
ment to offenders. A nationwide sample of adult probation agen- 
cies indicates that approximately 18 percent provide special 
treatment such as group counseling, halfway houses, or special 
programs for alcoholics or drug addicts. 239 Although not all 
treatment programs are pleasant, 240 they can usually be distin- 
guished from mere discipline or humanitarian kindness. The use 
of chain gangs in South Carolina is an example of confusion be- 
tween the concept of treatment and the concept of discipline or 
retribution. Working on a chain gang is sometimes justified by the 
prison administrators as helping prisoners to "work off" hostili- 
ties and frustrations and develop good "work habits." 241 The 
difficulty is not so much with the treatment theory, though this is 
certainly questionable, but with the failure to provide clear meas- 
ures of therapeutic effectiveness. The little evidence that is avail- 
able does not support the assumption that working on a chain 
gang will reduce subsequent offenses more effectively than stand- 
ard incarceration. 242 

In discussing the application of the cruel and unusual clause 
of the eighth amendment to the juvenile courts, a certain anom- 
aly exists. The juvenile court has been traditionally characterized 
as noncriminal and treatment-oriented. Therefore, because it 
does not punish the juvenile, the cruel and unusual clause does 
not apply. In Ex parte Walters, 2 * 21 a Criminal Court of Appeals of 
Oklahoma forbade a child of 9 years of age who begged on the 
street with her father from seeing her parents until she became at 
least 18 years of age. The petitioners argued that this violated the 
cruel and unusual clause. The court replied that, "[TJhere is no in- 
tention on the part of the State to punish a minor who is deter- 
mined by the juvenile court to not understand the consequences 
of its acts . . . [B]y reason of the nature of the hearing, and 

40 



281 

judgment complained of which does not attempt to inflict punish- 
ment, the constitutional provision cited is not involved." 244 Sher- 
man 245 has usefully discussed these limitations traditionally 
placed upon the application of the eighth amendment. 

In the context of increasing concern about the basic fairness 
of many juvenile court dispositions, the standards implicit in 
the cruel and unusual clause might be applied by "analogy" to 
the juvenile court situation. 246 Some judicial recognition of this 
possibility appears to be occurring. The court in In re Green 247 
commented, "Although criminal probation statutes are not per- 
tinent to juveniles, they are relevant to the basic question of 
specificity of formulation of the conditions of probation." 248 Also 
noteworthy is the case Workman v. Commonwealth, 2 ** in which 
the Kentucky Court of Appeals held that life imprisonment 
without parole of two 14-year-old boys for rape violated the 
eighth amendment because it shocks the general conscience of 
society. Certainly such a sentence could hardly qualify as 
lying within the treatment objectives of the juvenile court. 

As noted above, the concept of treatment is often confused 
with discipline or retribution. Intrinsic to the treatment of of- 
fenders by behavior modification techniques is the measurement 
of the effectiveness of the techniques in changing observable 
illegal behavior. The effectiveness of a technique in preventing 
subsequent offenses for long periods of time in the future might 
from a utilitarian, public safety viewpoint justify somewhat 
more aversiveness than those procedures only concomitant with 
the customary institutional or postinstitutional care of offenders. 
However, therapists should not be permitted to do under the 
label of treatment or behavior modification that which cannot 
also be done under the label of discipline. Ultimately the justi- 
fication of discipline or behavior modification is the safety of 
the community and not a supposed benefit to the offender who, 
if he were persuaded of such benefit, would generally consent 
to the treatment technique. 

Furthermore, judicially sanctioned incursions by either treat- 
ment or discipline techniques upon the fundamental concepts of 
decency as expressed in the eighth amendment reflect an evolving 
standard of judgment derived from the ethical milieu of the 
culture. In this context of changing or conflicting values, the 
court, or the legislature, would seem to be a more equitable forum 
for the open presentation and weighing of values than a treat- 
ment clinic or laboratory where the offender is typically at a 
decided social disadvantage. 250 It may be that behavior modifica- 



200 While the American Bar Association has been advocating shorter sentences and calling 
for more investigation of prison conditions, the Gallup Poll shows that from 1965 to 1968 

41 



282 

tion techniques will eventually have a distinct advantage over 
the more traditional forms of therapy by presenting data clearly 
demonstrating the effective promotion of public safety. Thus, be- 
havior therapists may ultimately persuade the public of a 
reluctant necessity for the limited use of very aversive but ef- 
fective techniques. However, in the absence of unequivocal evi- 
dence of long-term therapeutic effectiveness of a particular be- 
havior modification technique as routinely carried out by trained 
personnel, a similarity of standards for both behavior modifica- 
tion and discipline techniques would seem to provide at present 
the maximum legally enforceable protection for offenders. 

2. Due Process 

There is general agreement that the concept of "due process 
of law" as found in the fifth and fourteenth amendments has 
been increasingly applied in the area of corrections. For example, 
the courts have become increasingly explicit about the procedures 
necessary for legally valid confessions, findings of delinquency 
in the juvenile court, and the revocation of probation. Even 
though the changes in the application of the due process concept 
are clear, the definition of the concept itself remains elusive. 

In simplest terms, the concept refers to a sense of fundamental 
fairness. The fairness of legal proceedings, including investiga- 
tion and arrest, is to be considered as well as the fairness of 
the outcome of the trial. Although this sense of fairness helps 
to guide judicial decision-making, it cannot be readily reduced to 
a verbal formula because most cases involve the weighing of 
conflicting social claims. Also, what is considered "fair" pro- 
cedurally or substantively tends to vary over the years. 

In Rochin v. California* 51 Mr. Justice Frankfurter suggested, 
"Due process of law is a summarized constitutional guarantee of 
respect for those personal immunities which, as Mr. Justice 
Cardozo twice wrote for the Court, are 'so rooted in the tradi- 
tions and conscience of our people as to be ranked as fundamental' 
... or are 'implicit in the concept of ordered liberty.' " The Court 
found that forcefully "pumping" the stomach of the petitioner by 
giving him an emetic to obtain evidence of the use of a narcotic 
drug "shocks the conscience" and would "offend hardened sensi- 
bilities." 252 

Without clear guidelines, due process has come to be categorized 
under several rubrics of policy. Judicial decisions reflecting due 
process policy for persons under a disability are of particular 



there was an increase of 15 percent (from 48 to 63 percent) of respondents who indicated 
that the courts were not dealing "harshly enough" with criminals. Roth, L. H. Treating the 
Incarcerated Offender. Corrective Psychiatry and Journal of Social Therapy, 15:4-14, 1969. 

42 



283 

relevance to the treatment of offenders. A statute, sentence, order, 
or administrative standard may violate the due process clause if 
it fails to give adequate guidance to its addressees. 253 If reasonable 
certainty is provided by the directive and a general class of 
behavior is plainly ordered or proscribed by its terms, the direc- 
tive will not be invalid on due process grounds even though 
doubts might arise in regard to marginal cases. 254 

There has been a general reluctance of appellate courts to 
review the sentences imposed by trial judges or the conditions 
of parole or probation. When there is a review, particularly of 
probation conditions, the courts often look to a standard of fair- 
ness and reasonableness rather than to constitutional doctrines. 255 
This may be in part because probation, as well as parole, is 
viewed as a matter of "grace" and rehabilitation. Customarily, 
somewhat more discretionary leeway is permitted parole and 
prison authorities than probation authorities. For this reason, 
the following discussion will focus primarily upon the limits im- 
posed by the due process clause on behavior modification tech- 
niques in the context of probation. 

The statutory conditions of probation are often very general. 
For example, they may exhort the probationer to obey the laws 
of the State, 256 or avoid disreputable places or persons. 257 In ad- 
dition, the court is often authorized to impose conditions of pro- 
bation. These statutes usually allow very much discretion to the 
trial court. California's Penal Code, section 1203.1, provides that 
the court may impose certain previously specified conditions and 
"other reasonable conditions, as it may determine are fitting and 
proper to the end that justice may be done, that amends may be 
made to society for the breach of the law, for any injury done 
to any person resulting from such breach, and generally and 
specifically for the reformation and rehabilitation of the pro- 
bationer . . ." Finally, some authority may be given to the pro- 
bation officer to impose conditions. 258 

In the context of parole, authority to impose conditions is 
generally given i.o the parole commission or its equivalent and 
then delegated to the parole officers. There is implied in this 
situation an agreement that the probationer or parolee will not 
be imprisoned unless he violates one of the conditions of pro- 
bation or parole. 

The conditions imposed by the court or by parole officers may, 
however, be rather vague without contravening the due process 
clause, perhaps because probationers and parolees are considered 
to be under legal disabilities. A noteworthy example is provided 
by Kaplan v. United States, 2 ™ in which the trial court imposed 
upon the appellant, who had pleaded guilty to selling heroin, 

43 



284 

several ''usual" conditions of probation. Among these conditions 
were, "Live a clean, honest, and temperate life," and "Keep good 
company and good hours." The appellant later refused under 
court order to disclose to a grand jury the source of some heroin 
purchases. His probation was revoked and a sentence of 15 year's 
imprisonment was imposed. The court did not agree with the 
appellant's contention that he had violated none of the conditions 
of probation that were imposed upon him and noted, "One on 
probation is not at liberty; he is in law and in fact in the 
custody and under the control of the court granting probation. 
We also think there can be no doubt but what, aside from the 
written conditions of probation, there is an implied condition 
that the probationer will follow the reasonable directions and 
orders of both the probation officer and the District Judge." 260 
Even conditions as vague as "stay out of all trouble" have been 
allowed. 261 

It would appear therefore that there is considerable leeway in 
specifying the nature of the treatment in which the probationer 
is to participate. Treatment as in typical contingency manage- 
ment programs would be allowable. For example, a probationer 
might receive reinforcements, such as money or driving lessons, 
contingent upon his attendance at school or upon his social con- 
duct. Contingencies might also be changed during his term of 
probation, for as the courts often note, "No doubt it is diffi- 
cult to know in advance precisely what will be needed, and hence 
the cited statute [New Jersey Statutes Annotated, 2A: 168-2] 
expressly provides that the court 'may, at any time, modify the 
conditions of probation.' " 262 The contingencies, if changed, how- 
ever, must be clear to the probationer so that he knows with 
reasonable certainty what is expected of him and what conse- 
quences will flow from a violation of conditions. Further, because 
a probationer may generally not be imprisoned without violating 
a condition of his probation, it is customarily not permissible to 
revoke his probation solely on the basis that imprisonment might 
be a more effective treatment procedure. 

There are other limitations also set upon treatment by the due 
process clause. Although a probationer may be required to under- 
go some form of treatment as a condition of probation, 263 the 
treatment must be "reasonably related to the rehabilitation of 
the defendant" as well as "not unduly restrictive of his liberty 
or incompatible with his freedom of conscience." 264 Of particular 
concern here is the relationship of the behavior the probationer 
is required to produce or inhibit to the conditions of his probation. 
The behavior dealt with by the conditions must be reasonably 
directed toward achieving the objective of probation, namely, re- 

44 



285 

habilitation and the reduction of subsequent offenses. For ex- 
ample, it is possible to forbid a drug addict to associate with 
other users, 265 or a person who has been convicted of sending 
obscene matter through the mail to receive mail. 266 Likewise it is 
possible to prohibit an offender from seeing a woman whose 
son-in-law was a victim of an assault because she was "clearly a 
factor in his criminal conduct." 267 

People v. Dominguez 268 provides a clear example of a condition 
of probation not reasonably related to the objectives of probation. 
The appellant was found guilty of second degree robbery. In 
setting the conditions of probation, the judge stated to the ap- 
pellant, who had two illegitimate children, "The third condition 
is that you are not to live with any man to whom you are not 
married and you are not to become pregnant until after you be- 
come married. Now this will develop by just becoming pregnant. 
You are going to prison unless you are married first." 269 The 
woman became pregnant while on probation and the trial judge 
revoked probation commenting that, "It appears to me this wo- 
man is irresponsible; she is foisting obligations upon others, and 
one of the objectives of probation is to teach and encourage 
responsibility in all phases, including the economics of life and 
being able to support the dependents who will naturally flow 
from this sort of conduct." 27 ° 

In reversing the revocation of probation, the California Court 
of Appeal. Second District, used the following test : "A condition of 
probation which (1) has no relationship to the crime of which the 
offender was convicted, (2) relates to conduct which is not in itself 
criminal, and (3) requires or forbids conduct which is not rea- 
sonably related to future criminality does not serve the statutory 
ends of probation and is invalid." 271 The court then made the 
observation, "Appellant's future pregnancy was unrelated to rob- 
bery. Becoming pregnant while unmarried is a misfortune not a 
crime." 272 

Several points here are worthy of consideration as they may 
suggest due process limitations upon treatment. Treatment in 
broad perspective is directed toward the reduction of future of- 
fenses and may therefore, as noted above, be imposed as a con- 
dition of probation. But this assumes that the treatment so 
ordered as a condition is in fact related to a reduction of future 
offenses. The assumption of this relationship is often implicit 
and unexamined. Surely the imposition of alternating warm and 
cool baths as a form of treatment for robbery would no longer 
be acceptable as being "reasonably related" to a reduction of 
future offenses. But evidence is not always convincing that other 
forms of more customary treatment are related to the reduction 

45 



286 

of criminality. As discussed in the introduction, treatment in the 
form of counseling or psychotherapy is often ineffective 273 and 
occasionally it is even related to increased subsequent criminal 
behavior. 274 Behavior modification techniques, as well as counsel- 
ing and psychoanalytically oriented treatment methods, should 
be examined carefully in regard to their therapeutic effectiveness 
or hazard. 

It is highly questionable, as Dominguez indicates, whether in- 
effective treatment should be permitted as a condition of proba- 
tion or parole. 275 Conversely, one would expect that effective forms 
of treatment likely to reduce subsequent offenses would be par- 
ticularly consonant with the objectives of probation or parole 
and would therefore be looked upon favorably by the courts. 
There are some hints in this direction. In Faucette v. Dunbar 276 
the petitioner, a drug addict who was residing at Synanon House 
for the purpose of receiving a newly developed type of group 
therapy, was summarily ordered by the Adult Authority to move 
or suffer the revocation of his parole. The petitioner had also re- 
fused to take Nalline tests, a customary condition of parole, be- 
cause they were discouraged by Synanon House. 

The California Court of Appeal, Second District, affirmed the 
trial court's order requiring the Adult Authority to consider the 
petitioner's request to remain at Synanon House. The appellate 
court noted that the petitioner appeared to be doing well and placed 
emphasis on the possible therapeutic effectiveness of the treatment 
the petitioner was receiving. The trial court was quoted with ap- 
proval: "The respondent, Adult Authority, has not favored the 
Court with any evidence indicating that it has considered the use of 
Synanon facilities in its overall program for rehabilitation of 
addicts on parole. The Court is, frankly, unable to understand 
the lack of interest in such a proven technique for rehabilitation 
of addicts." 277 The court also suggested that the Adult Authority 
could waive its requirement of Nalline tests. The court appeared 
to be persuaded that the treatment had at least some probability 
of rehabilitating drug addicts and deserved consideration even 
to the temporary exclusion of a customary parole condition. 278 

Even though a treatment technique might be effective, such as 
the inhibition of homosexual behavior by classical conditioning, 
it shouM also be related at least in a general manner to the offense 
of which the offender was found guilty. The court in Dominguez 
pointedly asserted, "If the condition of probation is not directly 



2,8 The trial court appended to its decision a report by the California Assembly Interim 
Committee on Criminal Procedure highly favorable to the therapeutic potential of Synanon. 
This report noted that Synanon provided an "unparalleled opportunity for research" and 
urged the State of California to take a "friendly but nondirective interest in Synanon and 
any other private attempts to rehabilitate narcotic addicts." 

46 



287 

related to the crime, the condition may be invalidated." 279 In 
State v. Baynard 28 ° the trial court imposed several conditions of 
probation upon the appellant, who was convicted of operating a 
motor vehicle while under the influence of intoxicating liquor. 
Two of the five conditions imposed were that the appellant not 
go into or near any premises where intoxicating liquors were 
sold and that he not ride in any motor vehicle except for his 
business. The appellant contended that the conditions were un- 
reasonable because they did not grow out of the offense for 
which he was convicted. The court appropriately rejected this 
argument. 

Sometimes the relationship between certain conditions of pro- 
bation and the offense might not be clear unless the pattern of 
conduct of the offender is known. For example, a defendant con- 
victed of larceny in State v. Smith 2S1 was not permitted to operate 
a motor vehicle for 1 year. In the act of larceny the defendant 
had used a vehicle to haul away 900 pounds of seed cotton. An 
offender may be required to make resititution to a victim of his 
offense, 282 or to the local government, 283 but not to a person who 
is not a victim. 281 A notable exception to this general principle 
has been developed in regard to sex offenders in some jurisdic- 
tions. Sexually dangerous persons may be incarcerated for long 
periods of treatment when their original offense is unrelated 
to any sexual act. 285 This may result from an overriding con- 
sideration of public safety (or morals) applicable ideally to a 
narrow range of cases. 286 

Finally, although a condition of probation such as treatment 
may be reasonably related to the objectives of probation and 
likely to achieve these objectives, it must also meet a standard 
of fairness that does not offend a common view of justice. Though 
the concept of "substantive" due process has assuredly not been 
clarified by its "distinguished descent," 288 some sense of "ordered 
liberty" still remains. 289 In Springer v. United States 290 the ap- 
pellant refused induction into military service on religious 
grounds. One of the three conditions of probation that were im- 
posed was that the appellant donate a pint of blood to the Red 
Cross blood bank within 30 days. The appellant at the time 
did not clearly accept or reject the conditions. Later, the ap- 
pellate court tersely noted, "We regard the requirement that 'a 



2SS Dictum in Sas v. State of Maryland is worth consideration in this regard. After ap- 
proving the indeterminate psychiatric treatment of offenders, the court observes, "But a 
statute though 'fair on its face and impartial in appearance' may be fraught with the pos- 
sibility of abuse in that if not administered in the spirit in which it is conceived it can be- 
come a mere device for warehousing the obnoxious and antisocial elements of society. Many 
of the inmates of Patuxent are there by reason of offenses against property rights. Many 
jurists and laymen would seriously question the wisdom of the practice of indefinitely con- 
fining young men under these circumstances." 287 

47 



288 

pint of blood' be given as invading the physical person in an 
unwarranted manner and void on its face. It may be entirely 
disregarded." 291 The compulsory implantation or attachment of de- 
vices as a condition of probation or parole should certainly be 
subject to careful scrutiny. 

The comments of Mr. Justice Field in 1876 are still appropriate 
today, if not more so, because of the increased possibilities of 
technological incursions upon the person. 

No State "shall deprive any person of life, liberty, 
or property without due process of law," says the four- 
teenth amendment to the Constitution. By the term "life," 
as here used, something more is meant than mere 
animal existence. The inhibition against its deprivation 
extends to all those limbs and faculties by which life 
is enjoyed. The provision equally prohibits the mutila- 
tion of the body by the amputation of an arm or leg, 
or the putting out of an eye, or the destruction of any 
other organ of the body through which the soul com- 
municates with the outer world. The deprivation not 
only of life, but of whatever God has given to everyone 
with life, for its growth and enjoyment, is prohibited 
by the provision in question, if its efficacy be not frit- 
tered away by judicial decision. 292 

Nevertheless, such sentiments still find limitations, as they 
always have, in the tangible and complex situations of contem- 
porary apellate review. In re Peeler 293 is a noteworthy ex- 
ample. The petitioner, a 20-year-old girl, pleaded guilty to the 
possession of marijuana and the matter was referred to the pro- 
bation officer for investigation. Following arrest and prior to 
sentencing, she married a college student near her age against 
whom charges of furnishing marijuana and a dangerous drug 
were pending. The petitioner claimed no knowledge of the stu- 
dent's drug involvement and failed to inform the court of her 
marriage. Among several conditions imposed by the court were 
two: she was to live with her parents and she was not to as- 
sociate with any known or reputed user of marijuana. She later 
petitioned for the elimination of these conditions and the court, 
thereupon finding that she was married, imposed a 60-day jail 
sentence and reaffirmed the prohibition against her association 
with reputed marijuana users. Thus, the trial court essentially 
required her to live apart from her husband. 

After noting "the brink of the precipice upon which this 
petitioner precariously is perched," the appellate court reviewing 
this case concluded, "We have no doubt whatever that the facts 

48 



289 , 



before the court justified the imposition of the new conditions 
of probation." 2iK The appellate court added, "The trial court here 
has not severed the marital union of petitioner and Peeler [her 
husband] . Had it denied or revoked probation it would have more 
permanently affected the probability of the durability of the 
marriage." 295 

This goes very far toward reaching, or even surpassing, cus- 
tomary due process limits. 296 It does point out clearly the 
fact that probation is an alternative to incarceration which is a 
very severe penalty. It could be argued that the petitioner in 
Peeler could have chosen incarceration instead of separation from 
her husband or that she voluntarily waived her rights. A valid 
waiver requires that the person be physically and emotionally 
able to consent in a knowledgeable manner. The petitioner in 
Peeler would have been capable of this. As pointed out by In re 
Walker, 291 the courts should examine carefully those waivers of 
rights by which an offender, a drug addict in the instant case, 
seeks to obtain treatment rather than a criminal sentence. 298 

Two theories have been used to invalidate a procedurally suit- 
able waiver by a parolee or probationer by which conditions, 
such as inappropriate treatment, are imposed. The court, as in 
Dominguez, may consider the condition void, e.g., sterilization, 
as a matter of public policy and, as the State interest in this 
matter cannot be contravened by private agreement, the waiver is 
invalid. Essentially, there can be no waiver of a void condition. 
Another, perhaps more fruitful approach is that found in the 
doctrine of "unconstitutional conditions." 

Though this doctrine has been variously formulated, it would 
in broad outline suggest that the right of the government to 
withhold a benefit does not imply the right of the government 
to grant it only if the recipient surrenders a constitutional 
right. 299 Thus, a State may not be permitted to refuse the benefit 
of tax subsidies to veterans refusing to sign loyalty oaths because 
this would curtail a constitutionally guaranteed right of speech. 300 
But, of course, some rights may be validly waived by individuals. 
The doctrine would seem to apply particularly to those situations 
in which the government seeks a waiver of rights in an area 
not related to the purpose for which the benefit was given. 



298 Putting aside summarily the presumptive innocence of the husband, the appelate court 
suggested, "Our ruling does not extend to a blanket endorsement by this court of the separa- 
tion of husbands and wives as a condition of probation under all circumstances. Decision must 
be on a case-by-case basis." Id. at 261. 

298 The court found that the petitioner's story of a lack of understanding of the consequences 
of her waiver was lent credibility "by her headlong rush from illness to doctor's examin- 
ing room to county hospital to district attorney's office to courtroom to commitment, all in 
the span of a single working day." Id. at 19. The court also criticized the casual use of 
printed waiver forms. 

83-303 O - 77 - 21 _ 

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290 



Thus, a major consideration in determining- the validity of a 
condition attached to probation would be its relevancy to ob- 
taining the legitimate, governmental objective of rehabilitation. 

The policy underlying the use of the unconstitutional condi- 
tions doctrine is that the government is in a position to offer 
many benefits to petitioners and through bargaining techniques 
produce a potential erosion of fundamental liberties. 301 Further, 
it is not quite accurate to say that probation with the imposed 
conditions is an alternative to incarceration because the judge 
determines both the likelihood of incarceration and the terms 
under which that likelihood can be reduced by obedience to 
certain conditions of probation. It is in fact a single decision 
in alternate forms. By this decision-making procedure, due proc- 
ess is undermined because what is "due" is determined by the 
same authority. 

To prevent the concept of due process from becoming a mere 
tautology for the enforcement of subjective standards of fairness, 
administratively independent alternatives might be offered to 
the offender. Thus, for example, after the parole authority had 
decided that the inmate was not eligible for parole, an independ- 
ent correctional agency could recommend reconsideration of pa- 
role with the added condition of participation in a behavior 
modification program. Thus, inmates eligible for parole without 
treatment would not have the condition of treatment imposed 
upon them. Of course, many other arrangements are possible 
and suitable, but the goal remains of providing liberty in the 
community through an ordered process of decision. 

3. Equal Protection 

Although the fourteenth amendment rather clearly prohibits 
the States from denying to any person within their jurisdictions 
the equal protection of the law, 302 the equal protection clause was 
called by Mr. Justice Holmes "the usual last resort of constitu- 
tional arguments." 303 Mr. Justice Jackson, however, urged the 
more frequent use of the equal protection clause : "I regard it as a 
salutary doctrine that cities, States, and the Federal Government 
must exercise their powers so as not to discriminate between 
their inhabitants except upon some reasonable differentiation 
fairly related to the object of regulation." 304 

The "last resort" of the equal protection clause was used in 
1942 in the famous case of Skinner v. Oklahoma, 305 7 years prior 
to Mr. Justice Jackson's comment cited above. The relevant statute 



302 "jsjo State shall make or enforce any law which shall abridge the privileges or immu- 
nities of citizens of the United States; nor shall any State deprive any person of life, liberty, 
or property, without due process of law ; nor deny to any person within its jurisdiction the 
equal protection of the laws." United States Constitution, fourteenth amendment, sec. 1. 



50 



291 



permitted the sterilization of persons committing two or three 
felonies as habitual criminals. In delivering the opinion of the 
Supreme Court, Mr. Justice Douglas noted that "A person who 
enters a chicken coop and steals chickens commits a felony; and 
he may be sterilized if he is thrice convicted. If, however, he is a 
bailee of the property and fraudulently appropriates it, he is an 
embezzler. Hence, no matter how habitual his proclivities for 
embezzelment are and no matter how often his conviction, he 
may not be sterilized." 306 Because the statute was seen as draw- 
ing a conspicuously artificial line between intrinsically similar 
offenses, it was rendered invalid on equal protection grounds. 307 

It is noteworthy that the equal protection clause in Skinner 
was applied to the proposed treatment of the offender rather 
than to a determination of his guilt. However, in practice, appel- 
lants often invoke the equal protection clause in the treatment 
context, but not successfully. This can be understood perhaps 
in part if one considers the general correctional context in 
which the disparate treatment of similarly situated offenders 
takes place. 

As Rubin et al. 308 have pointed out, the granting of probation 
may vary as much as from 5 to 80 percent of the cases coming 
before various judges. The percentage receiving probation under 
these circumstances does not seem to be closely related to sub- 
sequent recidivism. To insist upon the clear drawing of distinc- 
tions in regard to appropriate types of treatment following pro- 
bation or release on parole would seem, as the old adage puts it, 
to be straining at the gnat while swallowing the elephant. The 
differentiation of treatment recognized by the courts is very 
broad. 

In Buchanan v. State, 309 the defendant challenged the Wisconsin 
Sex Crimes Act under which he was being treated beyond the 
maximum term that could have been imposed for his offense. His 
primary challenge was on due process grounds. But he also argued 
from an equal protection viewpoint that because mentally ill per- 
sons have the right to a jury trial prior to involuntary commitment 
sex offenders should have that right. The court disposed of the 
equal protection argument by noting a valid distinction between 
the purposes of the commitment of the mentally ill person and 
the sex offender. "There are several germane distinctions to the 
classification . . . the most important is that a sexual deviate is con- 



307 Mr. Chief Justice Stone in a concurring opinion suggested reaching the same result us- 
ing the due process clause. It is a point worth considering because surely the Court would 
not have been pleased if subsequently the State of Oklahoma proposed to sterilize all offend- 
ers, thus making no invidious discriminations among them. There has been some tendency 
to bring "substantive" due process considerations within the purview of the equal protection 
clause. 

51 



292 



fined because he is dangerous to the public, and the mentally ill, 
infirm, or deficient person is confined primarily for his own bene- 
fit and treatment." 310 Here, putting aside the therapeutic treat- 
ment implications of the operative statute, the court makes very 
broad distinctions that are not likely to be helpful to the offender 
in challenging alternative types of therapeutic treatment follow- 
ing a determination of his suitability for some type of treatment. 
Nor would the decision in the earlier case of Baxtrom v. Herold, 311 
which applied the equal protection clause through the fourteenth 
amendment to insanity proceedings whether they were labeled 
as civil or criminal, seem to reach this far. 

Thus far, though there has been some extension of the applica- 
tion of the equal protection clause, the decisions of the courts 
seem to be in line with the traditional reluctance of courts to 
intervene on equal protection grounds in matters of types of 
appropriate treatment for offenders. This is generally the out- 
come even when the statute under which the treatment is being 
conducted is very vague. The mental health or correctional agency 
is assumed to have a level of expertise that favors the development 
of appropriate categories of treatment and the assignment of 
persons to them. This appears to be particularly the situation 
when the problem addressed by the court involves public safety 
and its solution is uncertain. The Fourth Circuit Court of Appeals 
in Sas v. State of Maryland 312 directly declared : 

We must also reject the petitioners' contention that 
the Act upon its face violates the equal protection clause 
of the fourteenth amendment. The preoccupation of 
society with the problems of recidivism and rehabili- 
tation, which show no signs of solution by conventional 
penological methods, strongly support the efforts of 
Maryland to seek a new approach. The problem furnishes 
a rational basis for the legislature's efforts to set apart 
a group of convicted felons who were "demonstrably 
dangerous to society unless cured of their criminal 
propensities." 313 

Similarly, the New York Supreme Court, Bronx County, has com- 
mented, "When a subject is within the proper s