One doctor’s pain at Western State Hospital

Dr. Joseph Wainer is a psychiatrist at Western State Hospital in Lakewood.
Dr. Joseph Wainer is a psychiatrist at Western State Hospital in Lakewood.

“Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system.”

— Avedis Donabedian (physician and founder of the study of quality in health care)


When I see my patients, I see people struggling to regain their place in the world. I see people who suffered terrible neglect and cruelty and when they tried to get help, no one understood. The harder they tried, the more people pushed them away.

Those years of neglect, disdain and cruelty eventually led to violence, arrest and involuntary hospitalization at Western State Hospital.

A decade of caring for such patients has taught me to look beyond anger and violence and see the fear and terrible history of neglect beneath. Resolution of such anguish only comes in the context of a genuinely loving environment that doesn’t see caring for patients as just a job.

I am sincerely grateful to my patients, the staff I worked with, and to the state for giving me the opportunity to be part of such an environment. The experience has humbled me. It’s taught me that my years of medical and psychiatric training pale in comparison to the healing nature of a genuinely caring environment.

But now I find myself struggling with the trauma reflected in the hospital itself. I see an organization overcome with anger, frustration and fear, trying to make it through the day telling themselves that “it’s just a job,” telling themselves “I just do what I’m told” or telling others “just do what you’re told!”

I see people who’ve been told that their perspective is ignorant, who have been ignored, shamed and intimidated into silence by an increasingly authoritarian leadership.

In a TNT column more than a year ago, I stated: “An uncompromising priority to genuinely care for the health and safety of each individual patient and staff requires a hospital’s leaders to demonstrate courage. It requires a willingness to forgo politics and address the stark reality for what it is. This degree of courage has not been apparent over the past few years at Western State Hospital.”

In this regard, little has changed. Despite the tremendous influx of resources, the core problem remains. It can’t be fixed with something that you purchase. The deficit is in an intrinsic quality of leadership that instills the organization with a sense of trust and safety, instead of relying on brute force, deceit and intimidation.

Years ago, I learned to look beyond anger and violence from my patients. In the interim since I wrote the words above, I’ve had to repeatedly endure angry insults and threats, not from patients but from displeased executive leaders.

I’ve had to watch helplessly as administrative deceit and bullying of doctors, nurses, administrative assistants, etc., continue to escalate. I’ve had to watch helplessly as such behavior by executive leaders results in a parallel interaction between staff and patients.

My experience in addressing the trauma of patients has taught that I should look beyond the behavior of hospital leaders and simply see it as expressions of a traumatized organization. But I also know that the needed change must be from the top down.

I can only respond to leadership’s hostility and deceit with vulnerability and, above all, unrelenting honesty, or else fall victim to the same vicious cycle of trauma that consumes our organization.

I can only suggest that the intrinsic quality of love may offer those who lead our hospital the courage to heal themselves, our patients and our organization’s decades of neglect.

Dr. Joseph Wainer is a psychiatrist at Western State Hospital. His views are his own and are aligned with the Union of Physicians of Washington (UPW).