Race and Abuse in Inpatient Settings: What Happens Behind Locked Doors

Irvo Noel Otieno was a 28-year-old Black man who died of asphyxia due to being smothered by seven deputies in a Virginia mental hospital in March of 2023. This didn’t get as much publicity as the George Floyd case and I’m not even sure if it inspired any protests.

A very similar thing happened to me on multiple occasions. As a petite Mexican-American woman I’ve been physically assaulted by nurses and security guards so many times that I lost count. One incident in particular that I remember happened at Oregon Health and Science University in Portland, OR, I believe in 2011 or 2012, when I refused my medication because the doctor changed the dosage without consulting me. The male nurse called in a big burly male security guard to pin me down so that the nurse could forcibly inject me with medication. I remember the doctor actually being apologetic the next day saying they should have told me about changing my medication. When I asked another security guard about it, he angrily told me that they were there to protect staff not patients.

I had forgotten this incident and thought I had left it behind in the past. But an offhand remark from my psychiatrist suddenly brought back the memory and I started having flashbacks. I didn’t know how to deal with this and got upset, thinking that maybe I should discontinue my medication. I didn’t tell my psychiatrist (who I see via telehealth) right away but eventually when I told her I was really struggling she insisted that I up my dosage of medication and add an additional medication.

The doctor called me the next day concerned. I can’t remember our exact exchange but it ended with me asking if she had malpractice insurance and her angrily responding “That’s it.” Twenty minutes later I heard a knock on the door and the police came saying that my doctor had dialed 911 and requested that I be sent to the emergency room. Luckily I was able to defuse the situation, telling them I was tired and was trying to process the whole experience of being assaulted in the hospital by the security guard years before and refusing the free EMS ride. It was a rough week though and my regular doctor knew I was struggling with insomnia and dehydration.

The second time 911 was called later in the week I wasn’t so lucky—I went along with the friendly paramedics and with the cooperative ER staff up until the point they decided to triage me to psych. At that point they put me into what was basically a holding pen—an open area behind locked doors with no door to my sleeping area and fluorescent lights which did not allow me to sleep. The only staff was the third-party security staff that watched me. Some were kind, such as the elderly African American gentleman and Jewish lady who talked to me about their lives. Some were not.

At the end of the long night I was told by a nurse that I was being transferred to Raleigh, something I found really exciting since it meant that I would be out of the tiny provincial town and into the capital of the state. I was eager to go with the sheriff’s deputy, only instead of the female deputy that was supposed to come with me, a big brute of a man showed up. I was still excited up until the point he brusquely placed handcuffs on me and started dragging me through the ER. I was terrified and started screaming “Rape!” and “Code black!” and whatever I could think of to get people’s attention to get him to stop, but people’s expressions just indicated confusion or that they were glad that he was taking me away out of the ER.

As soon as we reached the squad car, he shoved me in the back seat, took a bottle of pepper spray and pointed it menacingly in my face, informing me that if I said one word he would press the button and the spray would blind my eyes. He closed the door without placing a seat belt on me and I spent the rest of the trip in silence.

The rest of my stay was somewhat mixed. No one took a history so I was taken off my medication and placed on something different. No one took note of my eating disorder (ARFID) so I went several days without eating as I couldn’t eat what was on my tray. I was in the room nearest to the front desk so when patients came screaming at 3 am I was woken up at a time when I desperately needed sleep.

The most helpful people I met were fellow patients—in particular I remember a Muslim holy woman who sometimes wore hijab who was often yelled at by staff for doing calls to prayer in the hallway. When I think of how some of the disorders like schizophrenia are diagnosed in terms of people believing they are experiencing visions or missions from God, it made me wonder if people like her are trapped in a system that seems obsessed with rooting out potential religious leaders.

I’ve had a chance to consider things like this since throughout the course of my life I have spent almost a year total locked up in multiple community hospitals and four different state mental hospitals, usually on the most serious and violent case wards. As a graduate student during most of these experiences, I was able to make lots of observations, taking a note from David Rosenhan’s infamous 1973 research carried out in locked psych wards (“On Being Sane in Insane Places”). At one point in 2006, I even wrote a play about what I thought the ideal mental healthcare of the future would be like, something that we have yet to reach.

I have vague memories of the commitment trials where the psychiatrists would testify why I should be locked up. In Champaign, Illinois in 2007, I remember the male psychiatrist saying that I needed to be involuntarily committed because I believed that I was autistic and had accused him of being a racist. In the most recent incident I wasn’t even allowed a trial and was IVC’d (involuntarily committed) for two weeks directly on the testimony of an ER doctor who thought my claims of being a scientist constituted “delusions of grandeur” (I have two master’s degrees and half a PhD in science programs but I guess that’s not enough for some people).

Psychiatrists seem to hate me because I am often noncompliant and tend to think for myself instead of blindly accepting whatever verdict they hand down. In times of crisis, I keep turning to psychiatry in the hopes that it will make me feel better when in fact it always makes things worse, adding on the numbers of physical assaults, the experiences of forced coercion and bullying and the overall feeling that I am not seen as a human being. When I’m off my meds I challenge authority and say what’s on my mind, including opinions about why the DSM is not scientific and big Pharma influences too many of the drug studies. And even when I’m back on meds I carry the memories of what happened.

In the aftermath of what happened to Irvo Noel Otieno and George Floyd, it is finally time for me to come forward with my story. This problem of staff brutality towards patients on the psych wards disproportionately affects people of color and continues to happen every day behind locked doors. This is backed up by the book The Protest Psychosis: How Schizophrenia Became a Black Disease by Jonathan Metzl. It goes beyond race because even though Black people may experience the worst violence in the system, the “mentally ill” in general, regardless of race, are considered the lowest caste in our society and bad treatment is deemed acceptable as we saw in the death of Jordan Neely. No more. This psychiatric survivor refuses to be silent anymore.