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‘Screaming homicidal maniacs’: ASH was world’s largest hospital for criminally insane

Psychiatric technician Tracy Jensen holds the daily patient meeting on Ward 12. Atascadero State Hospital was the world’s largest hospital for the criminally insane in 1987.
Psychiatric technician Tracy Jensen holds the daily patient meeting on Ward 12. Atascadero State Hospital was the world’s largest hospital for the criminally insane in 1987. dmiddlecamp@thetribunenews.com

I was in trouble.

Under normal circumstances, I’m usually able to navigate hostile environments.

But this wasn’t normal. I was in Ward 12 of Atascadero State Hospital.

A man whose face had been mashed in prison didn’t think I belonged. Everything I said angered him.

I was saved by a petite psychiatric technician, Tracy Jensen, who stepped in and redirected the agitated patient with a few words.

The staff at ASH work with some of the world’s most difficult patients in a facility that was designed when Harry S. Truman was president.

The hospital was built on a former dairy farm purchased by the state in 1946. The 308-acre property, centrally located between population centers in San Francisco and Los Angeles, was intended to provide open space for recreation and production of food for the institution.

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A single patient room has few frills at Atascadero State Hospital, which in 1987 was the world’s largest hospital for the criminally insane. David Middlecamp dmiddlecamp@thetribunenews.com

The first patients were admitted in June 1954, after four years and $12 million of construction.

From the beginning, there has been a balancing between the therapy-treatment model and the prison-punishment models.

In addition to the care provided to patients, the facility has provided the region with head-of-household jobs for generations.

Over the years there have been escapes, violent incidents and conflicts between management and the safety concerns of staff.

The ASH staff is currently working under “Lord of the Flies”-like conditions with a blocked sewage line that’s left about 77 patients without toilets or running water, according to a recent story by Tribune reporter Matt Fountain.

It may be time to invest in upgrades to the 60-year-old infrastructure.

In August 1987, Dan Stephens wrote a five-part series for the Telegram-Tribune about what was then “the world’s largest hospital for the criminally insane.” This was the third part of “Inside Atascadero State Hospital,” published Aug. 19, 1987.

Since the story was published, tobacco has been banned inside the hospital.

Ward 12: On the front lines helping brain-damaged patients

6 a.m. Ward 12. Atascadero State Hospital.

“Max,” who sodomized an old woman, jams his nose to a menu and good-naturedly reads aloud. He has trouble seeing. While in prison, somebody dropped 80 pounds of weights on his face as he was bench pressing.

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Atascadero State Hospital was the world’s largest hospital for the criminally insane in 1987. David Middlecamp dmiddlecamp@thetribunenews.com

Near the magazines — National Geographic is the favorite — “Vance” stands smiling, waiting to go to breakfast. He smiles often. He was a glue sniffer — he tried to beat up a policeman.

“Brian” is still in his room. Brian, an arsonist with a degree in philosophy, has been at the hospital 23 years, one of the veterans.

A few years ago, he tasted a Big Mac for the first time. He liked it, but after watching Big Mac commercials for umpteen years in the hospital, he couldn’t understand what all the fuss was about.

Just then, “Clyde” walks by the glassed-in nurses’ station that overlooks the day room. He’s an arsonist who hears voices. He uses neologisms — made-up words.

Clyde raises his arm above the glass, weaves it through the bars and offers Tracy Jensen a cigarette — a generic menthol — as she conducts a tour of the ward.

At Atascadero State Hospital, a cigarette is the ultimate gesture, the highest gift.

The smoke says what many psychotics here can’t.

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Psychiatric technician Tracy Jensen talks to one of her 26 patients at Atascadero State Hospital, the world’s largest hospital for the criminally insane in 1987. Sharing a cigarette was the ultimate gesture of kindness inside ASH at the time; tobacco has since been banned. David Middlecamp dmiddlecamp@thetribunenews.com

“Anytime they do something nice for somebody else — anytime they share. Its nice,” says Jensen, a 28-year-old psychiatric technician at the hospital.

“I’m interested in him because he has incorporated me into his delusional system. Sometimes he calls me an elbow. Sometimes he uses other words, and he’s the only one in the world who knows what they mean.”

It’s Friday. She’s in someone’s delusion. And it’s just another day at the office for Jensen, a 10-year veteran of the front lines at the hospital.

Max, Vance, Brian and Clyde — not their real names — are among the 26 men she works with eight hours a day, five days a week on Ward 12.

Suddenly “Clark Gable” walks by — Jensen has nicknames for most of the men. He sports a GQ mustache and looks dashing. “I call him Clark Gable. He calls me Carole Lombard.”

“He likes it when I smoke cigars with him,” said Jenson, lighting a Marlboro Light under an 8-by-10 foot photograph of a stream tickling the feet of snow-capped mountains. “It’s his way of trying to be kind.”

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Psychiatric technician Tracy Jensen, at right, waits with other employees to be checked through the security gate. Atascadero State Hospital was the world’s largest hospital for the criminally insane in 1987. David Middlecamp dmiddlecamp@thetribunenews.com

Jensen is supervisor of Ward 12, home for those who have brain injuries or brain damage. The staff numbers 10, including doctors and nurses.

Patients are referred to Ward 12 from other wards. Here, they try to regain mental skills lost because of disease or injury. Some need help in memory or attention span.

Twelve of the 26 patients came from prisons and are psychologically disturbed.

The other 14 were found not guilty of crimes by reason of insanity.

They are all ages and all sizes.

Here, patients are taught to clean their rooms, clean themselves and get along with each other — the basics.

The absence of such basic skills is one of the first signs of mental illness.

Ward 12 consists of two 50-foot-long wings that form an “L.” At their junction is the nurses’ station ad the day room. Single rooms line both sides of the wings. Ward 12 sparkles.

In the day room, patients watch television, beginning at 2 p.m. Majority rules on channel selection. Sports are big.

Or, patients can phone home — collect only.

Working with the mentally ill can take a toll on the workers. It can be trying. Working with the criminally insane can be risky.

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Psychiatric technician Tracy Jensen listens as a patient in Ward 12 reads a menu. Atascadero State Hospital was the world’s largest hospital for the criminally insane in 1987. David Middlecamp dmiddlecamp@thetribunenews.com

“I’ve never been the victim of a righteous assault,” said Jensen. “I have been hit and scratched but that’s trying to control a violent patient.

“The attacks on staff are not as common as people believe.”

Being a woman surrounded by male patients, Jensen is outnumbered. But her gender can work as an advantage.

“That’s one nice thing about being a woman,” she said. “There’s not point in me standing there taking it from a patient. I will get out of harm’s way.”

Some patients are more willing to compromise with a woman therapist than a male therapist, she said. Patients don’t feel as threatened or as challenged with a woman.

Still things can happen.

“A lot of the assaultive behavior is verbal,” Jensen said. “You haven’t lived until you’ve had a tongue lashing from one of these guys. Your have to keep in mind these guys are sick.”

Some patients hear voices that command them to hit somebody. The voices constantly berate the patient until he carries out the command.

“It’s hard to scrub the commode when a voice is capturing your attention,” said Jensen.

When someone does get violent and restraints are used, “it’s not a matter of cowboying him … taking him to the floor and tying him up,” she said.

Instead, employees are taught techniques that contain assaultive patients without hurting the patients or themselves. “We only use restraints as a last resort,” she said.

“This is not a game. They are only to be used when a patient is dangerous to himself or somebody else. Punishment is expressly forbidden.”

Many of the men have committed violent crimes.

“You have to get beyond what these guys have done,” she said.

“You can’t ruminate about it. This is a hospital.”

Workers do develop a sixth sense — a radar that detects possible danger from behind.

“In the supermarket I can feel when people enter my body space,” said Jensen. “It’s the same way here. But if you were constantly looking over your shoulder you wouldn’t survive.”

To remind her patients of the outside, Jensen and her staff turned a prison-like courtyard into a landscaped showcase. Pink roses and a fine crop of strawberries splash the courtyard with color. Patients hauled in the dirt from the outside, wheelbarrow by wheelbarrow.

Marvin Sumner, a nurse coordinator for 27 years, was having a smoke in the courtyard that day.

When asked about the “screaming homicidal maniacs” people outside believe are kept at Atascadero State Hospital, he said, “Ninty-nine and nine-tenths percent of the time you don’t see that. We do get society’s failures, those (who) society has failed to treat.”

Jensen is not the only Jensen at Atascadero State Hospital. Her profession is a family affair. Jensen’s father, mother and sister work here.

“I became a ‘psych tech’ by accident,” said Jensen. “I got a summer job in college at Napa State Hospital. And I liked it. I enjoy my job — not the Florence Nightingale type. I just enjoy it.”

She admits the job attracts a certain type.

“Most are intrigued by human behavior.,” she said. “They are real curious about what goes on in people’s minds. What they think. And most have some degree of compassion and empathy.”

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