About half of the patients at the Fall River MA Corrigan psychiatric facility suffer from conditions such as obesity, social anxiety, paranoia, PTSD, dementia, catatonia, etc. (the Compromised patients). These patients are among the most vulnerable members of our society. In many cases, they have been abandoned by family. They rely on the kindness of hospital staff.

Corrigan staff, however, renege on this important duty. Their treatment of the Compromised patients is inhumane and illegal for they deny the patients a fundamental Human Right., viz. daily access to the outdoors. A newcomer to the unit will be appalled that half of the patients never access the outside. It is stomach-churning to see a Vietnam Vet, whose favorite activity is daily walks with his sister, shut inside, day after day, and staff does nothing about it. (Corrigan does not even track when the last time a patient was outside.).

A cognitively impaired woman in her late sixties also does not have real access to the outside at Corrigan. She spends weeks, even months, inside, and her skin is deathly white. If an intern takes her outside, she flourishes. She sits with the sun on her face and dances to another patient’s music. But the social workers at Corrigan (Danielle Keogh and Mel [Last Name?]) are unsupportive. They want the intern to sit inside with the patient. That is what they expect, and doing something more is a sign of insubordination to them.

One MHC compliments the intern, saying “I can’t believe you just did that!” But the other staff are actually actively hostile and actively resistant. The next time the intern tries to take P out, the staff purposively block his efforts. They say they will take him and her down in the elevator, but they leave them at the elevator bank. Fifteen minutes of trying to get someone to take them down: to no avail. One nurse won’t look the intern in the eye. An MHC says she can’t because she is “on checks.” Another MHC smirks “I’m not working today.” Ultimately, a new charge comes on and offers the blanket conclusion, “We don’t have enough staff for that.” The intern asks, “Can I take her down in the elevator?” The charge nurse says, “No that is against policy.”

The intern then goes out to the courtyard to see why the MHCs did not take him and P down, as they said they would. What he sees is upsetting to him: there are three MHC’s there, chatting around the table. There are only two patients on the break. In other words, there was no reason the staff couldn’t have taken P and the intern down. When confronted, they are surly and evasive. The intern thinks to himself, “They will surely make me pay for this.”

These are public-sector, unionized workers. They are not constrained by the usual neoliberal workplace ethic of acting like their incentives are aligned with the patients. The daytime shift MHCs are free to be their authentic selves and show their distaste for the work and the patients.

When the intern goes back and reports in the notes how the MHCs blocked his attempt to take P outside, Danielle Keogh, LICSW says that the note was “unprofessional” and shouldn’t have been written. (She has a strange set of incentives. She is what you would call, not patient-centered, but perhaps “Joint-Commission-centered.” She has a keen sense of hierarchy. She kisses up and demands submission from below. Everything is about the upcoming “audit.” Everything must appear different than it is in reality).

Ms. Keogh did not hold the required weekly supervision meetings with the intern. She withheld any praise for what the intern brought to Corrigan. She only really wanted him to be a source of free labor to do grunt tasks for Mel. Like arrange post-discharge primary care appointments which the patients (suffering from paranoia, PTSD, and a panoply of negative symptoms) were never going to go to. (Again: appearance over reality. Having made a primary care appointment meant the social workers had planned their treatment!) When the intern finally cornered Danielle Keogh LICSW to talk about how upset he was about P not going outside, he made an unpardonable error in Ms. Keogh’s mind. No stranger to PTSD himself—someone with lived experience himself—when it became clear Keogh was not going to support him in this, was, indeed going to criticize his note as unprofessional, his voice quavered. He was saying something to her, and then he felt saliva gather at the back of his throat. He had to stop in the middle of his sentence. He had to swallow.

To Ms. Keogh, that was a sign of emotion. And that meant she went from being withholding of praise to downright hostile. You see mental-health practitioners are not the sharpest knives in the drawer. Their awareness of emotions is rudimentary. The world is bad people who abuse, and then others, like them, who are “professional.” And “professional” means you can hate as much as you want. You can be as cruel as you want. But it was to be done with a surface of politeness and zero emotion. It is like Rachel Levy-Bell, a ball of hate under a cover of polite.

There is a truthful kernel under the social worker’s hatred of signs of emotion. But what they fail to be able to distinguish is the difference between emotion and dysregulation. In addition, it should be okay—even encouraged—for a social work intern to display emotion in supervision. But Ms. Keogh presumably is focused on making sure her superiors are happy. That means nothing coming up from her department saying that things are bad. She used the sign of emotion as a reason to turn against the intern. She began to contact the authorities at his school. She talked to them about him. She wrote a negative evaluation, and she planned an ambush on his last day to try to take away all credit for the internship.

The hatred within social workers is beyond the pale. The classic explanation for why a person chooses social work is, of course, that their do-gooding is a reaction formation for their internal aggression.

Back to the outdoors issue and Corrigan’s inhumane and illegal treatment of the Compromised patients.

I spoke above about the nonprofessional staff. I also spoke about social work. Another class of workers at Corrigan are the “providers.” These are the prescribers. They don’t have a better description because some but not all are nurses. They come from a range of school degrees. Osteopaths, podiatrists, etc.

The most visible provider at the Corrigan IPU is Maxwell I Mayer. He does put a high value on the outdoor time. He does value access to the outdoors during the four schedule breaks.

Unfortunately, it is his own, personal access that is important to him. He likes to take part in the breaks. He values playing basketball in the sun.

But he does not extend that to the patients. Compromised patients apparently do not need to get an hour of fresh air a day. It is essential for him. What is it about the patients that he does not see that for them it is as essential (or more, since he gets to go outside whenever he is not at work, and they never get to go outside). Perhaps it is just required as a provider to dehumanize the patients. (cf. the opening of The Knick). Or it could be a more shallow reason. Provider Mayer displays his talents at basketball during the breaks. Perhaps he thinks that outdoors is important for athletes. Perhaps he does see the disabled Vietnam vet and elderly pallid P as human. It is just that their time, their rights are not as important as someone like him who is optimizing every hour of the day to self-actualize as much as possible. Or, less cynically, to be as effective as possible.

Life is overdetermined. I suspect there are multiple sufficient reasons that each member of Corrigan staff can put aside the disgust about the Compromised patients not have true access to the outdoors. I myself learned to live with it. Ultimately, you are just a cog in a machine at Corrigan. You are left with the Serenity prayer. Is this the sort of thing you can change? You would have to change the entire physical plant, and as the intern’s experience shows, you are going to meet resistance at every step if the “wisdom to tell the difference” tells you to fight.

In addition, “fresh air” may be a Human Right under Massachusetts law, but it was the last Human Right to be added. (It was not added until 2015). And whether you call it science or scientism, disengaged reason reigns in medicine. Buddhism was only allowed through because of the Relaxation Response. Maybe the providers view the 1 hour outdoors as soft. Indeed, it appears to have been advocated for by patient advocates. Corrigan has a quite good patient advocate, whose name I can’t remember right now, but eventually one does get tired of hearing her go on. The importance of making sure every patient gets a cake on their birthday. Yawn.

The right to go outdoors for one hour per day is indeed backed by some prestigious entities. Or at least entities with armed men behind them. The United Nations (through the Nelson Mandela Rules) requires one hour of fresh air for prisoners. The Commonwealth of Massachusetts. But providers like Mayer have no problem disagreeing with the law. They are set up as antagonistic to the law every time they try to keep a patient in the unit when the patient is asking to be let go.

When our social work intern first decided to contact The Man about the glaring problem, he simply felt that the white-skinned Vietnam Vet and patient P as well needed to get outside. He had also heard that prisoners get one hour outdoors every day. Shouldn’t psychiatric patients receive the same affordance? He looked up the Massachusetts regulations and found that, as interpreted by the regulations, the law has a huge gaping escape route. So huge it is more of an escape highway. (Predictably, the advocates were upset when the regulations were made public).

Corrigan strangely has the inpatient unit on the third floor. What was a psychiatric hospital to do if its physical plant was not conducive to getting patients outside? This is a draft, incomplete longform. We are stopping it here mid-paragraph. We intend to complete it soon.