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Locked Down

Can strongarm tactics help troubled teens overcome their personal dilemmas?

by Betty Bean

The pictures in the brochure are lovely, starting with the full-page color photo of misty mountains and tall pine trees. There's one of a counselor working with attentive-looking girls in front of a crackling fire, another of kids paddling a red canoe over blue water, and a bright, autumn shoreline peeking through the fog.

The text describes Peninsula Village as a residential treatment facility for hard-to-reach adolescents ages 13-18 who suffer from drug abuse, depression, conduct problems, eating disorders, and self-endangering and/or out-of-control behaviors. The brochure says the program is affordable, innovative, and above all, successful. It features a number of outdoor activities, including building, landscaping, and farming.

Located in Blount County on the banks of Lake Loudon near the Peninsula Hospital complex, Peninsula Village is made up of two campuses, one for boys and one for girls, with a separate schoolhouse on each campus. It looks like summer camp.

Angie Montgomery, administrative director at Peninsula Village, says the average length of stay is eight or nine months, although the Village is developing a shorter-term treatment program as well. The program does not accept psychotics, fire starters, or children with IQs below 85. There are currently 92 patients at the Village, which she says is entirely separate from Peninsula Hospital and Peninsula Lighthouse, which are located in the same area and are under the same ownership.

A parent's handbook explains that the program uses Native American symbols and philosophy, providing patients with a rite of passage--the Vision Quest--guided by the Medicine Wheel, where living creatures learn to live in harmony.

Friendly, vivacious Amy, who completed her Village stay last year and has come back for a post-holiday visit, had been in six other treatment programs and considers herself living proof that the brochure is not just full of pretty pictures and empty claims.

"I'm grateful for this place," she says. "I'd be dead if it weren't for it..."

Amy's friends had a surprise for her on this visit: she was presented with the Village's highest honor--the Buffalo, which the handbook describes as the "animal of Wisdom...He has turned his own difficulties into a way of life in which he reaches out to others with similar problems without losing sight of his own needs and process...The Buffalo is awarded rarely."

The Village's clinical director is psychologist Vance Sherwood, who has been there for 8 years. He says the present-day activities, which evolved from an intensive chemical dependency program conducted in a restricted setting with no distractions, "is very much my design." He also says it is considered one of the very best in the country.

"Most of our business doesn't come from Knoxville," Sherwood says. "Since 1990, we have been marketing nationally. We are a major national player."

But some observers--including former patients and employees--find Peninsula Village to be overly harsh in its treatment of troubled adolescents.

The Village boasts a success rate of around 80 percent, which its critics say is unnaturally high. As proof, Sherwood cites a detailed outcome study conducted by in-house staff who collected data on 101 ex-patients. Criteria for success included no further psychiatric hospitalizations after discharge, no trouble with the law after discharge, and satisfactory adjustment to work or school.

Amy, for example, counsels other Village graduates who live near her home in Charlotte, North Carolina.

The Village treatment plan begins with the Special Treatment Unit, or STU, "an extremely intense therapeutic experience... unlike other locked unit programs... specifically designed to address resistance and introduce patients to our group-oriented treatment approach, which uses peer pressure to create positive change."

Sherwood says new patients are "fairly homogeneous. They all might be described as out of control. Most are heavy into drugs, wildly labile, and prone to fits of anger and depression. Many are treatment failures. These kids care very little for adult authority, but are hypersensitive to peer pressure."

Once a change in attitude is affected (namely, when the adolescent is more compliant to authority figures), patients move out into the cabins, where they begin what a former patient who wants to be known as Elizabeth calls "the Indian program."

Elizabeth, who is 17, says that her seven weeks in STU were anything but therapeutic.

"At first, I was kind of happy to be going," she says. "I wanted to go-- had my bags packed for two weeks. We [she and her mother] went and saw the cabins. It was like camp, with log cabins. They didn't tell us anything about the STU. That was a big shock. Things started to go down when they put me in a straitjacket. It's called a burrito...I would be in the middle of the floor where everybody could watch me..."

Elizabeth was diagnosed with bipolar disorder--commonly known as manic depression--when she was 7 years old. This diagnosis is somewhat controversial in some segments of the world of mental health care, where some psychiatrists--albeit a dwindling number--insist there is no such thing as bipolar disorder in children. Elizabeth, her family, and her psychiatrist have no doubts about her diagnosis.

In 1994, amid a bout of severe depression, she was having great difficulty relating to her peers, who teased her unmercifully. So the school system, with her mother's consent, made what is called an "educational placement" and enrolled Elizabeth for long-term treatment at Peninsula Village.

The results were disastrous. She spent a little less than two months in the locked building that is the first stop for new patients, who are required to stay there for an extended period before they can move out into the mainstream of the Village's wilderness program. The length of stay in STU varies according to each patient's responsiveness to the rigorous STU regimen.

Patients in the STU have their clothes taken from them, and although they are allowed to write letters home, they cannot receive mail or talk on the telephone with their parents. They are dressed in hospital gowns if they are deemed "elopement risks" or violent. Otherwise, they wear hospital scrub suits until they earn back their street clothes.

Less serious outbursts are handled by attendants who take offenders down to the ground and hold them there. More serious episodes may land patients in a "burrito" (straitjacket) or in five-point restraint--bound limb and torso with leather straps to a bed. Doors are locked, windows are covered, and lights are on 24 hours a day. Patients are escorted to the bathroom.

To prevent kids from forming "anti-therapeutic cliques," patients are not allowed to talk to one another or to make eye contact. Every move is monitored, and they must ask for permission to speak to attendants.

Sherwood believes he knows who Elizabeth is and says he made a mistake admitting her in the first place; that he gave in to the importuning of her mother to allow her into the program. Elizabeth's mother denies this claim, saying her daughter was placed there by the school system.

He says the STU is designed to force patients to work on their own problems and to work together as a group--to become responsible to their peers.

"We offer intense treatment you don't get anywhere else in this nation. This program is for people whose lives are messed up in a major way, on their way to ruining their lives or someone else's. Most of these kids are multiple treatment failures, and when they fail at the Village, they don't have many options left."

Elizabeth never progressed past STU, and was released (actually thrown out of the program) in far worse condition than when she was admitted.

Elizabeth was, and still is, under a psychiatrist's care and was taking medication to control her symptoms. Both she and her mother believe that her downward spiral began when the Village staff (against the advice of her psychiatrist, John Robertson) cut down on her Trilafon, an anti-psychotic drug she had been taking for some time. Journals that Elizabeth's mother kept of conversations with the Village social worker (whose job it was to serve as a liaison to the family because STU patients are not allowed to speak with their parents) show that the Trilafon dosage was cut in half.

Elizabeth, who was threatening to kill herself, was discharged from the Village in handcuffs and transported into town, where Dr. Robertson found a bed for her in the Children and Adolescents Psychiatric Services (CAPS) unit at St. Mary's. She was there for six weeks for treatment-resistant psychotic mania. It is hard for her to remember everything that happened, but she insists she wrote letters home that her mother never received, and that an attendant "busted" her lip during one of her manic episodes.

Marilyn, the mother of a boy who is a successful Village alumnus, says she is glad she didn't know about the STU. Her son was deeply involved with marijuana and alcohol, suffered from depression, and was confrontational with his family. Like Elizabeth, he was placed at the Village by the Knox County School System.

"Most of our good fortune is because we didn't investigate. We didn't know what STU was. He was there for three and a half months--he was rebelling. He hit the carpet a lot. If a child was acting up, they'd push an alarm button and take the child down to the carpet for a count of ten. If that didn't stop it, a doctor would be called in to administer a shot in the buttocks, and they'd be taken to bed to sleep it off for 8 to 10 hours. That blew my daughter away [when she heard about it afterward]. She said 'What are you doing to my brother?'

"But we had been down that road so many times...Finally, he earned a place in a cabin."

Marilyn is so grateful to the staff at the Village that she does volunteer work there. She did art work illustrating Native American themes and gave this interview. She says one of the most important things she has learned is that "If our child happens to relapse, we don't have to relapse with him...And what the Village did was help us re-establish trust."

One former Village employee who worked on the STU says he disapproves of the methods used there.

"I wouldn't want my kid to go there. I would want my child to be in a structure that is more caring. This seems more like prison, or a prisoner of war camp."

This former employee says he was not successful at the Village because his personality was "unsuited" for their program.

"They wanted me to be stern, to use a military-type approach. My approach is more caring, to help the patients along. I didn't have that in me...One thing that really bothered me was that the patients were not allowed to speak. They've got to raise their hand, got to be acknowledged by staff, and a lot of times staff would just ignore them. There was a guy who left when I first started--a nice guy. The caring type, didn't last long. They said that doesn't belong here. They want their type of structure..."

Larry Gibney, chief juvenile probation officer of Knox County, says the Village is OK by him.

"I don't have anything bad to say about those folks. They have been a consistent, stable care provider. There have been a dozen other care providers who've come and gone, but they've been there..."

Joshua Williams is the president of the Tennessee Psychological Association as well as former director of Children's Hospital Integrated Psychiatric Services (CHIPS), that shut down last year. He says Peninsula Village "is viewed with ambivalence by mental health professionals. I've been privy to outcomes both positive and not positive."

He says that Sherwood "is licensed, inspected, and accountable to the licensing board for health care facilities. The physicians are accountable and the hospital is accountable. That doesn't make it [treatment in the STU] less repugnant. I work under the premise that civil rights are inviolate. Food, shelter, basic safety--humiliation is not therapeutic, in my view. If you describe those conditions to me, I would say that's sadistic."

Sherwood reacts sharply:

"I'll tell you what's sadistic--to take someone whose life is going down the toilet and let them go."

Amy and her friend Claire are a little older than Elizabeth and do not share Elizabeth's negative feelings about Peninsula Village. It's the first week after the holidays, and they have returned for a visit. Amy is attending a community college back home in North Carolina; Claire, who says she was pregnant and addicted to crack cocaine when she became a patient at the Village, is preparing to go off for her freshman year at the University of Maine. They are both glad to be back.

Amy fingers the silver buffalo medallion around her neck, signifying her great progress and her contributions to the other girls at the Village.

Claire wants to work here as a counselor one day. She, too, thinks the Village salvaged her life.

"I was into some deep stuff," she says.

The two Village alums are joined for a walk in the woods on this unseasonably warm January day by two soon-to-be-discharged Village residents, Emily and Jennifer. As they crunch through the dead leaves, all four point out things they built--a porch on the Village schoolhouse, a greenhouse.

They are proud. Emily and Jennifer say they're a little scared to be thinking about leaving, but like Claire and Amy, they are looking forward to the future. Jennifer wants to be a doctor; Claire a civil engineer; Amy a landscape designer; Emily an architect (it is probably not a coincidence that the program at the Village includes lots of digging, hammering, and sawing). They are all clear-eyed and friendly.

Jennifer gets teased, in a friendly way, for her sharp New Jersey accent. She says she has been in eight prior treatment programs and that she is at the Village because of her mother.

"My mom is very dedicated to me. She was going to send me to a treatment program in California, but then she found out about this one. This is the best in the country."

When the girls hear about Elizabeth's experiences in the STU, they recall their own stays there.

"STU gets you back to earth because when you come here, you're so stuck up," says Amy.

"I spent four and a half months there, but at the end, I didn't want to leave STU," Claire chimes in.

Jennifer, who spent a relatively brief six weeks in STU, has mixed feelings.

"When I first came here, I was absolutely defiant. I showed up at STU with a cigarette."

But she goes on to elaborate: "STU wasn't all good," she tells her friends. "There was a lot of not hearing what I had to say. I'd had surgery, and they didn't believe me when I said there were calisthenics I couldn't do. In a way, I don't blame them, because I lied so much. But I wouldn't be where I am now without STU."

She says she misses her family, "But I'm really afraid I'll mess up when I leave."

As the girls talk about their lives, a group of patients from a boys' group troop by, steadfastly staring at the ground.

The contrast between Elizabeth's story and those of the other four girls couldn't be starker.

One observation is, however, easy to make. Amy, Claire, Emily, Jennifer, and the unnamed boy were all serious substance abusers with problems that, though severe, were not uncommon to similarly situated young people. They, and probably their families, obviously believe they have benefited from the rigorous discipline and the 12-step philosophy at the Village.

Elizabeth was not a user of alcohol or illegal drugs. Her problems stemmed from a medical condition over which she had little control, and it broke her when her medication was reduced at the same time she was placed in a tough new environment and separated from her mother.

Sherwood says Elizabeth's is an isolated case.

"The Village really changes the lives of these kids. It's great to be able to say our program really works, because it does. The thing that makes most of us view it as Camelot is we take these horribly twisted, destroyed people and make them start again. We do something here that's precious."