Inside a Forensic Psychiatry Unit: The Ground Where Death Meets Life

Editor’s Note: This is the second in a series written by Sean Gunderson, who was detained by the criminal justice system for 17 years after receiving a “not guilty by reason of insanity” verdict. The series documents the life of a forensic psychiatry patient—a world that few know, and which has rarely been written about by a former inmate. New pieces will be published the first weekend of each month. The full series is being archived here.

We are quickly approaching the detention center (DC). I must brief you before we enter. As you will be embedded with me, it is imperative that you stay close to me. It could mean the difference between survival and perishing in the DC. I need you to understand that, in general, these mental health professionals are not here to help you.

I know, maybe you had some positive experiences with your psychiatrist or counselor outside the DC (in “The World”). However, there is an important difference here.

Briefing

You see, the history of psychiatry is characterized by the psychiatrists being aware of the limits of what society can tolerate when it comes to their abuses of those in their custody. Out in The World, the narrative that mental health professionals are “here to help” requires enough supporting evidence that society will continue to believe in it. Thus, your psychiatrist is incentivized to get you to believe that you are being helped, as you are the ideal proponent of psychiatric legitimacy (a happy customer is the best salesperson). Indeed, real help may even occur within this context.

However, in the DC, there is no need to actively construct the narrative that psychiatrists and other mental health professionals are really helping. The narrative associated with the not guilty by reason of insanity (NGRI) verdict has already accomplished this. That is, once found NGRI, the individual is sent to the DC under the assumption that they are being helped. So long as they stay within the limits of what society considers acceptable treatment for a forensic mental patient, psychiatrists can do as they please.

The intersection of the categories of “mentally ill” and “criminal” means that things psychiatrists could not do in The World are considered socially acceptable in the DC. Much of society would rather not even have to think about what goes on in the forensic psychiatric DC, and the narrative that these people are being “helped” dominates any social conversation about it.

If you try to tell yourself and me that these professionals are “here to help” I will send you off on your own to survive in the DC. You are not going to drag me down with you.

This does not mean that you will not encounter individual staff members who truly want to help. Indeed, finding these people is imperative to your very survival. It is so integral to your survival that you must use all your faculties to assess individuals for who they are, unencumbered by the narrative that tells you who they are supposed to be. You need to figure out on a case-by-case basis if any individual is really here to help. I advise you to start developing your intuition for human nature, if you have not already done so. If you doubt your own ability to do this, that is what the “true vision goggles” I gave you in the intro are for.

You will quickly see that most of these staff just don’t care about you. They will have you rotting away for decades if it is the easier path for them. Don’t make it easy on them by giving them your trust without them having to earn it from you. You matter because you are human, too. They do not deserve you just handing them your trust. Society already handed them its trust, and now they have the power to do whatever they want to you. You will experience the “true colors” of anyone you meet, and you must assess them for your own survival.

Welcome to the DC. This is psychiatry in the raw!

Scenario

This is what happens when you really piss off your psychiatrist:

I was so effective at ditching the brain-damaging therapeutics (BDTs) that I could do so under most circumstances without getting caught. I was very much a “stealth ditcher.” Not only was I highly effective at the actual act of concealing the fact that I was not taking the BDTs, but I was also able to maintain the micro-narrative that I was taking them.

Most staff are operating with the micro-narrative that inmates need the BDTs to control their behavior. If they don’t have their BDTs, then they will give themselves away through overt acts of unstable behavior, what we would call “mentally ill shit” in there. So, the staff were expecting inmates to lose control, which would lead them to enforce the druggings through various tactics, like crushed drug orders by the psychiatrist and court orders.

But in general, I never gave myself away. I was able to maintain normal observable behavior, and even appear to be doing well, without taking my BDTs.

However, my psychiatrist, who I’ll call “Dr. Medusa,” did not take kindly to the eventual discovery that I was ditching. When she confronted me, I acknowledged it. I was stuck on this idea (to my disadvantage) that long-term stable behavior while ditching BDTs would show the staff how well I could do off them. I was trying to construct this into a micro-narrative. That is, if I was able to demonstrate a long period of behavioral stability and then tell the staff that I had been off the drugs during that period, then they would finally stop coercing them on me. I was generally unsuccessful in my attempts to construct this micro-narrative. Often it backfired, and this instance was an ideal example.

Dr. Medusa seemed to like me at first. She seemed friendly and on my side. She would tell me how well I was doing month in and month out at my monthly meetings with the treatment team, which was about the only time I saw the psychiatrist. These meetings were short, especially if I had few behavioral problems the past month. (For me, it was an all or nothing thing. I either had no behavioral issues or major ones.)

After a string of monthly meetings in which I was praised for doing so well, I was discovered. I admitted to ditching for the duration of the meetings in which I was praised, thinking that the treatment team would actually adopt a new perspective on me. I failed miserably at the construction of this micro-narrative. Not only did Dr. Medusa not care that I could do well off the BDTs, she seemed personally offended to find out how long I had been ditching under her custody.

She probably realized in that moment how she had been praising an unmedicated inmate for months on end in front of her colleagues. She was likely embarrassed, as she was supposed to be the leader of the treatment team and the one best suited to spot behavioral abnormalities in inmates, including ditching BDTs.

At the time I did not see this dimension of my micro-narrative construction. Perhaps in the haze of the DC, I too had come to believe that my “treatment team” was here to help me. A brush with death helped to wake me up from that haze.

A Brush with Death

There are three ways that you can be killed in the DC. The first and most common is the one that most do not think about. This is a slow death over the course of decades as you are left to rot in the DC, probably drugged up beyond anything that you have ever imagined before. Your life slowly slips away from you, and you feel it happening. This will be referred to as a socially acceptable death (SAD).

The drugs, once referred to by psychiatry as “brain damaging therapeutics,” are “effective” at reducing so-called symptoms by reducing global brain function. So, just as you feel fewer negative “symptomatic” mental states, so too do you feel fewer positive “unsymptomatic” ones. What you are left with is just the altered state of the drugs themselves, which is usually painful in some way. It could manifest anywhere from mild discomfort to full-blown akathisia. Akathisia is a medicalized euphemism that describes a state of continual internal torture where it hurts to be alive, and hurts even more to try to be still.

When my psychiatrist found out that I was ditching, she threatened to kill me this way. She said with grave seriousness that I would remain at Chester Mental Hell1 Center (CMHC) for the rest of my life and that I would also remain on BDTs for life. In subsequent monthly meetings she stood her ground and refused to entertain any conversations on issues of BDTs or leaving the maximum security CMHC for the medium-security Elgin Mental Hell Center (EMHC). I tried in vain to construct a micro-narrative that it was important to have a plan to allow me to “demonstrate trust” to ultimately get me off the crushed drug order and a step closer to a transfer to EMHC. I was in despair for months as the lengthy administration of BDTs wore me down.

The second way to get killed is to commit suicide. Tragically, I have known inmates who took their own lives. In the haze of the DC, it was impossible to tell if an inmate committed suicide because they could not handle life in the DC, or if there was some “clinical” reason. Perhaps in the DC, the line of demarcation between hopelessness due to circumstances and hopelessness due to a “mental illness” is so blurred it is irrelevant.

The final way to get killed in the DC is to be murdered. This can and does happen, even though it is rare. If an inmate was going to get murdered while as an NGRI in Illinois, it would almost certainly happen in CMHC.

The culture was filled with staff who were former military, and units came to be known by words. So even though the units were labeled A, B, C, D and E, they were known as Able, Baker, Charlie, Dog, and Echo. I was on Baker at the time.

As I recall, in early 2008, we began to hear rumors that an inmate, a young man, was murdered on Charlie. At first, I did not really care as it did not affect me. Indeed, I was desensitized to death, as it was a real possibility while in the DC, so I had no reason to dwell on the death of an inmate whom I never met and was on another unit. However, as more information arrived through the staff on our unit, I began to take interest in this event. I and another inmate, G.C., began to try to find out more about this when we heard that the murdered inmate was a civil inmate (not connected to the criminal justice system) and the killer was allegedly a forensic inmate. There was an outcry from the victim’s family, and we heard rumors there was a lawsuit.

Apparently as a part of this incident, the Illinois Department of Human Services (IDHS), which manages forensic psychiatric DCs, ordered CMHC to restructure itself and separate inmates into homogenous units, either all forensic or all civil. The two populations were no longer allowed to live on the same unit.

As forensic inmates, G.C. and I began to focus on the possibility that we might get moved. While we recognized that we had no control over how the restructuring would go, we both hoped that it would take us away from Baker. The culture on Baker was probably one of the most restrictive at CMHC. I wanted out to get away from Dr. Medusa, who had threated to kill me with a SAD.

G.C. was a gangster type who just did not like being on a restrictive unit. He was stuck in the system, likely for life, as he fell into the legal cracks in the system. I recall that he was a long-term Unfit to Stand Trial (UST) inmate who had not even had his trial for a murder. He called his legal status “not not guilty.” However, G.C. was not the typical UST inmate; he was high-functioning, which is jargon used to indicate an inmate who can handle his affairs without prompting by staff. He did not appear stereotypically “mentally ill.”

G.C. was just too high functioning for me to believe that he was genuinely “legally unfit” for years on end. Later in my 17 years, I would come to realize how the UST legal status is easily abused. Mental health professionals in forensic psychiatric DCs have been given the power to hand out these labels at will.

As the situation continued to develop, we began to hear joyous rumors that Baker would be designated civil and Charlie as forensic. We were going to get extracted from the nightmarish Baker unit! Once confirmation came that we were going to Charlie in a month or so, we began asking the staff what life was like on Charlie. There was a little inter-unit rivalry present among the staff as each unit had its own “identity.” That is, the culture on each unit was unique and staff generally took pride in whatever that culture was because they helped to shape it. The staff at Baker were proud that it was known as one of, if not the most restrictive unit at CMHC. They scoffed at the liberal, laid-back culture of Charlie, where G.C. and I were headed. However, most staff acknowledged that we as inmates would appreciate it.

I was very optimistic that by moving units I would be able to get off the crushed BDT order initiated by Dr. Medusa. I also had hope that with a new treatment team, and essentially a new start, I would be able to get out of CMHC altogether.

Inmates were moved one by one from Baker to Charlie and vice versa. When my day came, I was eager to leave Baker. Good riddance to a restrictive unit with a psychiatrist who threatened to hit me with a SAD.

From Baker to Charlie

I arrived on Charlie-1 in or around late winter or early spring 2008. At CMHC, each unit had three modules and the “3 modules” (e.g., Charlie-3) were for the rowdiest inmates. As I was stable at that point, they sent me right to Charlie-1. I could tell rather quickly that Charlie was more laid back.

At CMHC, we were allowed to “receive, possess and use personal property unless it was considered a danger to self or others” according to the Illinois statutes governing the DCs in IDHS. This differed from prisons in the Illinois Department of Corrections (IDOC). Due to this statute, we were allowed to receive packages of personal items, including snack items, clothing, books, and certain electronic devices like mp3 players. The snacks would be kept in a closet, and we would have access at specific times.

While on Baker, they were strict. You could only have 2 snack items and you had to eat them in the dayroom where staff could see you. You see, a rule was that you could not trade or share any personal item and staff would enforce this. You could receive a unit restriction if caught sharing anything, including your personal food. You could not go to the gym, the yard, or the library if you shared a granola bar with a hungry inmate. You would also get this added to your “medical chart” and it could follow you as you try to construct micro-narratives to convince the power players in the system to give you the next privilege toward release. So not only could you miss the all-important gym tomorrow, but you could end up unintentionally constructing a micro-narrative that you are a “rule-breaker” and get stuck in the DC for years on end because you chose to give that hungry inmate with a sad look in his eyes a protein bar.

I recall that during my first snack time on Charlie, I followed my training from Baker and took 2 items and sat down at a table in the dayroom where staff could easily see me. I preferred to not ask about rules but use my legitimate ignorance of being new to the unit to allow the staff to tell me rules. If I asked, that might create a new micro-narrative. Such eagerness was dangerous. It was always better to have the excuse of not knowing the rules in case you unwittingly broke one.

Also, I wanted to start off on the right foot with them as this was my chance at getting out of CMHC. Much to my surprise one of the two “regular” staff approached me and instructed me to “take that to your room.” While his tone was non-threatening, he was nevertheless adamant that I could not eat my snacks in the dayroom. He explained that since not all inmates were fortunate enough to have personal food, many would beg you to the point of harassment and even violence as they were so hungry from being underfed (as well as from the BDTs, which can give you a ravenous hunger as a side effect).

So, while Baker prioritized exercising power to prevent you from trading or sharing and to tell you where to eat and how much, Charlie prioritized a smooth workday. It just led to fewer issues by having you hide while you ate. I was happy to oblige, as I preferred to eat in my room. Also, I could easily save some for later. You see, on Baker not only did you have to eat the food in the dayroom, but also it was against the rules to take food to your room.

As I was adept at the construction of micro-narratives by this point, I did not ask whether it was permissible to keep food in your room, as opposed to eating the items within 15 minutes or so of snack time. I recognized that I was just given implicit permission to have food in my room and my newness to the unit would allow for plausible deniability should they search my room and find a few protein bars.

My life had just gotten 100% better. I had hope of getting off the BDTs (or at least being able to return to ditching them), getting sent back to EMHC where I could actually work toward a conditional release, and I also got to eat food in my room. I was living the best life I could in the DC at that time, all due to the murder of a man whom I will never know.

At CMHC there were always two staff on any unit and, generally, they would act like a team. They would be known as “regulars.” Since they were the primary ones responsible for the unit, they had great power to shape the culture. Indeed, one of the common complaints discussed in CMHC’s inmate council meetings was that such an arrangement allowed for the creation of fiefdoms in which the regulars could do almost anything they wanted. This was a legitimate complaint and really, your best bet was to hope that you landed on a unit with a fiefdom into which you could smoothly integrate. Otherwise, you faced daily conflict that could result in forced druggings, restraints, seclusion, physical violence, abuse, neglect, and even murder.

I suspect that the murder of the man that led to my arrival on Charlie had something to do with this dynamic. He probably was unable to integrate into the culture for whatever reason and faced daily conflicts on an otherwise laid-back unit. Perhaps he clung to the belief that he was in a hospital and, when the staff behaved in a manner contrary to such expectations, he openly communicated it, as one might do in a real hospital. While I may never know the story of this man whose sacrifice saved my life, I can recognize that this is a plausible explanation.

Who Gets to Laugh?

I met Horace N. while on Charlie. Horace was a Black man and about 65 years old. He moved like an obese 65-year-old, which is to say not that well. On top of that, he had pronounced tardive dyskinesia (TD). TD is a terrible side effect of most dopamine antagonist drugs (which includes nearly all “antipsychotic” drugs). TD is like having Parkinson’s disease. However, it does not develop naturally; it is given to you with the long-term administration of dopamine antagonists, the very BDTs that I was ditching every chance I got. The shaking can get rather intense.

It is hard to put into words how bad his TD was. When I met Horace N., I could see that most of his strength went into minimizing the trembling. He might be able to reduce it for 10 seconds or so and then, when he relaxed, the trembling would start again.

Not only that, Horace was totally disoriented. He would get on the unit phone, not dial a number, then begin to have a lengthy conversation with the “US Suuuupreme Court.” Sadly, the content of his ramblings had to do with how CMHC was abusing and mistreating him. In his world, he was trying to process the abuse the only way he could figure out: to call the US Supreme Court in an attempt to secure justice. How convenient for him that he did not need to know the actual telephone number for the Supreme Court; he could just talk into the phone and his hopes that someone would hear him would carry his words to the Court.

In retrospect, I will not call his thoughts “delusions.” Recall from the first essay in this series that such a narrative has little room to be applied in the DC. Furthermore, in that essay I told you to put on your “reality-proof vest” (RPV) so that you could have the power to make your imagination real to find the will to survive. The RPV is a tool that inmates use to help them get through the nightmare. Horace just had his RPV on and was dealing with very real trauma the only way that his abused and tortured mind could figure out.

Everyone laughed at Horace. Laughter serves to demarcate the pecking order in a forensic psychiatric DC. Who you can and cannot laugh at determines how far up or down the totem pole you are. The more inmates that you could laugh at, the better off you were socially. Staff could (and did) laugh at nearly all inmates. Everyone, including other inmates, could laugh at Horace, yet Horace had no one else to laugh at. You see, it’s not just the laughing at others that demarcates the pecking order, it is also with whom you can share the laugh. Staff could laugh with each other. Some inmates could laugh with staff. Yet other inmates could laugh with other inmates on the same level as them.

At the bottom of this pecking order was Horace, as even other low-functioning inmates could laugh at his antics while on the phone. At least other low-functioning inmates called real people and were not observed talking to a receiver that was beeping to indicate it was off the hook.

And yet, the staff said that Horace N. stomped the victim to death. They asserted that because Horace supposedly used to be a boxer in the prime of his life, he was somehow capable of stomping another man to death.

Having met Horace N., I did not believe that he was the murderer. Horace could barely get food into his mouth with a spoon due to his TD, and we were expected to believe that he killed a young man. The funniest thing about Horace was the narrative that the staff attached to him. It was so unimaginable that it was laughable.

I have dwelled on this significant turning point in my life for years.

More recently, another murder of an inmate at CMHC, Lovely Jefferson, made me revisit my original thought that staff paid an inmate to murder the young man. I had previously imagined meeting the man who indirectly saved my life and asking him how many cheeseburgers the staff paid him to kill another human being. Indeed, bribing inmates with food was common for getting them to do things on behalf of staff, including beat up other inmates. I thought it plausible that the same agreement could have been reached for a murder.

However, after reading the details of the Lovely Jefferson case, I realized that staff probably just did it themselves. Perhaps they stole Horace’s shoe and stomped the young man to death with it and then blamed Horace.

As inmates, we all felt the fear of staff invading your cell. The first night that you are there, they get as many staff as possible to invade your cell to give you a “talk.”  This talk is intended to intimidate you and ensure your behavioral compliance. Staff do not hold back during these “talks” and you may forget if you are talking to taxpayer-funded hospital employees or members of a criminal organization. I played the Lovely Jefferson scenario in my mind and, when I did so, I realized that it is more plausible to believe that I was indirectly saved by murderous and corrupt staff than by another inmate fighting for their own survival by performing a hit on behalf of staff.

How Did I Get Out?

I was recommended to return to EMHC by the summer of 2008 and I arrived back at EMHC in early November, the day after Obama was elected president. So, I went from a fate of rotting in CMHC for life, drugged up and drooling on myself, to having a chance at survival in EMHC. You see, as CMHC was the maximum-security facility in Illinois, one could not secure a conditional release from there. In fact, CMHC generally refused to release any inmate directly from itself. Rather, inmates would be sent to other facilities if their release date was approaching and CMHC did not intend to take them to court to extend their detention. A lifetime in CMHC was shortened to about 6 months because of this murder.

How did I get out? It just so happened that the psychiatrist on Charlie unit was an open-minded Indian man. He recognized the benefits of meditation and yoga, which I had been practicing daily since my NGRI verdict in 2005. Not only was I stable, I professed an adherence to Hinduism, ate a vegetarian diet, and openly practiced meditation and yoga daily. I must have been a bright spot to Dr. R. I am grateful that we crossed paths, even though a most despicable act led to his ability to help me on my journey.

As a part of his plan to get me back to EMHC, he even took me off all enforcement measures to ensure that I was taking the BDTs. Of course, I went into “stealth ditcher” mode almost immediately and, despite the abrupt withdrawal, I remained stable and returned to EMHC to continue my journey out of the DC.

Debriefing

In The World, we use narratives of morality to help us guide our actions on an individual and collective level. Often, there is a legal structure attached to our moral ideologies that serves to incentivize adherence to the particular morality. That is, we may face punishment if we act immorally. Conversely, we may receive benefits if we act morally. In society, I can easily see how this helps to structure the flow of human interactions. Not all of us may agree with a particular moral system, but nevertheless we recognize that there are benefits in applying such a system, including social stability.

Furthermore, moral systems can help us to make sense of reality. Why do bad things happen to good people? One narrative would answer that all people have free will and some use this power to behave morally while other use it to behave immorally.

In The World, one chooses to use moral systems to help them navigate reality. If you want to avoid ending up in some type of DC, a good general plan is to refrain from any sort of physical violence toward another human being. If you do this because you assert it is the moral thing to do, then that particular moral ideology has helped you navigate yourself away from ending up in a DC. Good for you! I encourage you to continue to apply your moral systems successfully in The World.

However, if you ever really find yourself in a DC, such a tool for navigating reality will likely fail you. As I was not on the unit with the victim, I can only arrive at various plausible hypotheses about what led to his murder. I certainly know well how a murder can happen at CMHC. Perhaps the victim was adamant that a certain type of morality was expected in a hospital and, when he was not treated by staff in accordance with this moral system, he spoke up. After all, many moral systems suggest that the morally correct thing to do to is to point out injustices as they arise, especially to government employees in a democracy.

Maybe he “spoke the truth” to the staff and refused to stop, as the deviation from the ideal of a “hospital” was pervasive in CMHC. I can envision staff gradually increasing their coercive pressure to get him to be quiet. At some point, after lesser forms of coercive pressure failed, staff decided he just needed to die. Under such a scenario, adherence to moral systems that may have served him well in The World ultimately got him killed. This is why I have concluded that moral systems formulated and applied in The World are ineffective as tools to help one navigate reality in the DC. Once you enter the DC, you have to leave your old morality behind.

Inside a Forensic Psychiatry Unit: The Ground Where Death Meets Life