Editor’s Note: This is the first 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.
I am so glad that you are taking an interest in what life is like in the forensic mental health system. I lived that life for 17 years and in a very real sense, I am an expert on it. My expertise does not come from talking about the forensic mental health system as an observer, but rather living it and talking about my experiences as a participant-observer.
I have tried to take an ugly topic, one that is difficult to talk and read about, and make it fun and interesting, which is challenging to say the least. To be blunt, life in those places is nightmarish, especially when one does not know how the future will play out. Here I am, almost two decades after the initial events that led to my finding of Not Guilty by Reason of Insanity (NGRI), and I am able to discuss my experiences openly because they are finally over.
I have always wanted healing, but I was in the custody of not just people, but also an ideology. When my healing did not comport with the expectations of the medical model, I found myself in a struggle for survival.
Currently, the only narrative available for interpreting life in a forensic mental health facility is one-sided, discriminatory, and based on the intersection of medical model psychiatry and criminality in the US. Such a narrative is inadequate for truly understanding life in these places.
The current narrative casts forensic mental patients as “dangerous people who need medical model-based treatment in order to return to society.” While this narrative is useful for the community to justify the ongoing detention of forensic mental patients, it serves little purpose for helping the community to understand real life in those places. As this series is intended to help the audience understand real life in a forensic mental health facility and not to merely contribute to the justification for detaining human beings as forensic mental patients, I had to depart from the standard narratives we use to talk about forensic psychiatric institutions.
As I was contemplating the best way to present accounts of real life in a forensic psychiatric institution, I struggled to find the terminology to be able to capture a very complex and convoluted situation. Indeed, it is so unique that people who have never lived through it cannot understand it.
However, I realized there was a salient narrative that could potentially capture the constant, intense nature of the conflict that is at the heart of daily experience in a forensic psychiatric institution. This narrative is that of military conflict. First, it is easily recognized and understood by the audience. Next, it is highly effective at capturing the unique type of human conflict present in these places. Finally, it is creative and allows me to take an ugly, miserable topic and transform it into something that could interest almost anyone. However, there is another reason why I chose the military conflict narrative.
There are few situations in life where the threat of death is so immediate. Military conflict is certainly one of these. The constant threat of death and harm seems to activate an animalistic survival instinct in human beings. When a soldier is in combat, self-preservation instincts take over. The mind of the solider is vigilant and intently focused on survival. The only thing that really matters is surviving the situation. The rest of the life of that soldier can only be realized if they survive, and the soldier recognizes this as an animal being hunted by death. Death or serious physical injury could be around any corner and the soldier must be prepared to look death square in the eyes and defend themselves.
The emotional intensity of war caused by this constant confrontation with death and injury translates well to daily life in a forensic mental institution. It is this constant state of vigilance against the threat of death and injury that is at the heart of daily life in a forensic mental institution.
Between the daily conflict and threat of death and injury, the military metaphor is ideally suited to serve as a literary device to help you, the audience, truly understand real life in a forensic mental institution—including not just events, but also feelings and mental states.
Welcome to a new frontier in human experience. I will be your guide on a complex and convoluted journey that will take us through the Illinois forensic mental health system, including the historical and infamous Elgin Mental Health Center. Before we depart, I am going to issue you some important conceptual tools that you will need on this journey.
I will use the term “detention center” (DC) throughout this series. This term is used because it is broad enough to encompass various types of institutions of detention from a forensic mental institution to a jail to a prison to an immigration detention center (to name some salient examples in our current society). However, this term is also broad enough to include other types of detention centers such as concentration camps, institutions of forced servitude (i.e., enslavement), and really any social situations in which an artificial culture is created and maintained along the lines of a unique type of social division: those who cannot leave and those who can.
When these two groups are forced to exist in the same location for long periods of time, unique things happen that do not happen in The World. (Inmates in almost any DC refer to life outside the DC as “The World”). First, the aforementioned social classes of those who can and cannot leave do not even exist in The World, so nobody living in those newly created classes has any outside reference point to help them understand how to navigate the complex social situation, whether as an inmate or staff. Second, these two classes are artificially created and imposed upon real human beings. The classes have little to do with any other type of social classification found in The World. The dividing line is simply those who cannot leave versus those who can. This social classification cuts right through and supersedes other types of classifications that exist out in The World, such as wealth, race, gender, etc.
You will be guided from the perspective of a unique figure within the class of people who cannot leave.
In general, DCs have ideologies attached to them which influence the artificial culture that arises and is maintained within them. A forensic mental institution is informed by different ideologies than a prison, yet both share the commonality of a strict division of classes between those who can and cannot leave. One cannot understand any type of DC without understanding this unique class conflict.
The name “staff” will be used to describe the class of people who can leave. “Inmates” will be the term used to describe the class of people who cannot leave. The conflict between the two classes exists because the staff must create, impose, and maintain an artificial culture upon the inmates against the resistance of the inmates. Inmates are no less human than the staff, no matter what led them to the DC. They still want to be human after being forced into the DC and will find ways to express their humanity within the limits of the imposed culture.
Next, I share with you the concept of a liaison. A liaison is one of the most significant members of the culture in a unit and/or the entire DC. One cannot understand DCs without understanding the role of a liaison. Lucky for you, I happened to become a liaison when I was confined in the Illinois forensic mental health system for almost 17 years. A liaison is a unique and complicated figure that arises organically out of a dialectical tension between the staff and inmates.
Both groups have an interest in constructing a culture that is agreeable to them. However, as they are forced into a superior (staff) and inferior (inmates) division, there is a certain “natural” rule that governs. This natural rule is the rule of consensus. If enough individuals of both groups agree to a certain type of culture on an individual living unit or the entire facility, then that becomes the culture. It is a sort of unofficial democracy that exists. That is, there is generally no official voting that occurs; rather, there is simple a consensus among those who share the most power.
A liaison is always an inmate who is seen as a leader by the other inmates with whom they live. Ongoing friction (between a superior and inferior class forced to live together in a close-quarters environment) results in a continual reshaping of the culture. The friction constantly creates a sense of instability which often is remedied by the liaison.
Both inmates and staff have incentive to ensure stability of the culture. For inmates, it mitigates the difficulties of being detained. For staff, it makes their job much easier. That is, if the inmates consent to a specific type of imposed culture, then there is less resistance among them. It is this mutual incentive which facilitates the consensus among major powers in both groups needed to “elect” the liaison. Consent is an extremely powerful force in a DC; indeed, it is the stabilizing force.
Power is a broad concept, but it is necessary to recognize how it operates in the DC. Governmental/official power created the institution which in turn uses its social legitimacy to create and maintain a binary class division. Staff powers include: making rules; punishing inmates; accessing and editing an inmate’s official records; communicating officially to the court about the inmate; having the presumption of correctness while interacting with inmates; granting access to events and items behind locked doors; searching inmates cells; knowing the intimate details of inmates’ lives; administering prescribed drugs to inmates; being able to tell inmates to do almost anything; and other powers resulting from their “parental” status over inmates.
However, inmates also have power themselves for various reasons: banding together into factions that may or may not use violent or coercive force to help shape the culture of the unit or facility; power previously held while out in The World; logic, reason, and effective argumentation; and the application of the law, among other forms of power.
The power of the liaison arises differently in different DCs. A liaison in a forensic psychiatric DC will likely look different from a liaison in a prison. The power that brings them to the position of liaison is different, as is the way the liaison subsequently applies the new power resulting from their liaison status. For example, a liaison in a prison may arrive at this position through overt violence and intimidation of both inmates and staff. However, a liaison in a forensic psychiatric DC would likely not use such violence as it is just not very conducive to acquiring power in those circumstances. While these are just examples, the takeaway is that the culture of each DC and indeed each living unit within each DC is unique and it is the unique tension between staff and inmates that gives rise to a particular liaison.
The liaison, once “elected,” has both great power and great responsibility. They have the responsibility to bring stability to the culture. Inmates look to them to create a comfortable-as-can-be culture on the living unit and/or facility. The staff look to them to do much of the work of maintaining an artificial culture so that the staff can allow the culture to function “on autopilot”; that is, with minimal intervention from them. Those readers who have been confined to or worked in a DC, especially for a prolonged period of time, may recognize these people as the ones who would “run the unit/deck.”
An example of a liaison is the “capo” described by Viktor Frankl in Man’s Search for Meaning. Based on the descriptions provided by Frankl, it appears that the capo was essentially fulfilling this liaison role. The capo was a Jewish person confined to the concentration camp who would receive perks from their German captors for helping to control the other Jewish inmates, sometimes brutally. While a manifestation of a liaison in a Nazi concentration camp would differ substantially in the type of power needed to rise to that position and the manner in which it was applied once attained, I can see the underlying themes which I have described present in the capos. In short, capos, like other liaisons, were inmates who helped to control the culture to make the job of their captors easier.
It is important to note that not all living units have a liaison. That is, if there is inadequate consensus among the staff and inmates as to whom should be in that role, then there will be no liaison. However, both groups are incentivized to find and “elect” one. For the inmates, it ensures a more stable and “less uncomfortable” experience, and for the staff it offers an easier workday.
This little thing is far better than a compass or GPS system. It is your Inner Guidance System (IGS). A compass or GPS can only guide you in the physical world. However, your IGS can help you to find yourself within as well as to navigate the treacherous social environment through which we will be journeying. The trick with the IGS is that you need to remember to actually use it. There is no automated feature; instead, you will have to use it by connecting with that still silent part of you that many of us refer to as intuition.
You may think that such a thing would be easy to remember to use. However, in the midst of the zone of active human conflict into which we will be entering, it is easy to get distracted by the constant suffering that will be going on within and around you. At times it may hurt so much to be alive that you will not want to look within. Your life may be a daily nightmare that seems like it will never end. You may find yourself struggling to face the day and desperate for any distraction from the suffering within and around you. Ironically, these are the most important times to use your IGS; indeed, it may save your life.
You will need these, they are “strange nostalgia binoculars.” During prolonged psychological trauma resulting from extended periods of detention, I found myself looking back upon certain aspects of my experience with this strange nostalgia. That is, I remembered certain events with a mental filter that excluded all the negativity from them and what was left were the few elements of the experience that were positive. I call it strange nostalgia because one simultaneously recognizes that these memories were formed from experiences of the present moment, in which there was substantial distress. However, that distress does not make it into the memories.
I could recall feeling a sense of strange nostalgia when I would look back at softball games in the nightmarish Chester Mental Hell Center (not a typo). While each moment was a living nightmare, I would recall the games with a certain fondness. Indeed, I would engage in this strange nostalgic reflection to distract myself from the living nightmare that was the present moment. I give you these binoculars so that when you encounter situations that are just too difficult to think about, use them and you will only see the few positive elements present there. The negative 99% will be filtered out and the positive 1% present in that situation will remain.
Here, you will need these, too. They are “true vision goggles.” The true intentions of various people in there will be substantially obscured. You will have trouble distinguishing staff and inmates that can help you from those intent on harming you. These goggles will illuminate the “true colors” of individuals. Do not fall into the trap of believing that just because you see one good person in there who intends to help, that others surrounding them are on the same page.
This is your standard issue weapon. No, it is not a gun, knife, or club. In fact, it is not really considered to be a weapon at all in traditional human conflict. Your standard issue weapon is actually an integral part of who you are as a human being. It derives from the very humanity that will be taken from you once you step into the DC. This humanity will be taken by the narratives that justify the artificial class construction of those who cannot leave versus those who can. This standard issue weapon is simply your awareness. Lucky for you, the staff and society takes these narratives seriously so they will overlook this weapon, though it is a very real threat to any DC. They will generally forget about it, as they are hypnotized by the dehumanizing narratives used to maintain the strict class division.
You will need to be careful to protect your standard issue weapon. Due to the environment, various factors can reduce the acuity of your awareness and, thus, the efficacy of your weapon. These include the gross lack of mental stimulation in everyday life; stress; previous or current trauma; Intentional Infliction of Emotional Distress (IIED or double-IED) by malicious staff; and brain-damaging therapeutics (BDTs). BDTs is the term that will be used to describe psychiatric drugs (i.e., medication). BDTs was an original way to conceptualize such chemicals at the time of their inception.
It is far more useful to understanding their role in the DC by returning to that conceptualization instead of using more modern ones that obscure the intent of the use of such chemicals in the DC. Certain staff recognize the potential for BDTs to be weaponized against inmates. We will be journeying through a zone of active human conflict, and I would not want you, the reader, to be misled and put in danger with a euphemistic narrative.
Always secure your standard issue weapon, as we will face IIEDs, which is what can happen when staff recognize and oppose your application of awareness. Be especially careful of IIEDs in situations where there is a power struggle between the staff and inmates. If they realized that your awareness can be applied effectively to secure your freedom, they would likely consider it contraband and try to reduce its acuity as much as possible prior to entry into any DC. Use your weapon prudently. Trust me; it will save your life.
Be on the lookout for additional “weapons” that you can pick up while you are in the DC. These weapons are tactics that can help you influence your environment. They will help you to construct “micro-narratives” which counter the official narrative and which you will need to find freedom. Your standard issue weapon alone will be insufficient to secure your freedom.
Put this vest on. It is a “reality-proof vest” (RPV). It will stop reality in its tracks and give you the ability to make your imagination real. You may need to use your imagination to convince yourself of nearly anything in order to find the will to survive. While some may construe this as advocating for fantasy or even delusional thinking, the concepts of fantasy or delusion do not capture the very practical nature of imaginative thinking while in the DC. This type of thinking is a grey area. It is not quite fantasy, as you may find yourself really believing it.
Yet, using labels that imply symptomatology are not a clean fit here. Symptoms of a so-called mental illness must interfere with your ability to participate in the life of whatever culture in which you find yourself. Making your imagination real may actually help you survive the DC, and thus using the term “delusion” can obscure the very real and practical benefit of using your RPV to survive a DC.
While believing strange things may interfere with your ability to hold a job in The World, these same beliefs may save your life in the DC. You will be under extreme duress and your mind may play tricks on you. You will need to be OK with thinking things that you may consider strange if you were in The World. Indeed, your imagination may help get you through this ordeal so that you can return to life. Trust me, your very survival necessitates a new kind of relationship to your own thinking. Nothing is really “off the table” on the inside.
The only thing I must caution you about is to stay aware of what is deemed acceptable to talk about in the culture of the DC. If your ideas would be considered acceptable in the context of the culture of the DC, then you can share them if you choose. However, if they would not be considered acceptable, I advise you to keep them within your RPV—it may save your life. But always remember that this vest is rather heavy and do not let it interfere with your ability to assess staff and inmates’ personalities for potential allies.
Finally, this is a sight for your standard issue weapon. It is the best problem solver you can use. It is called an attitude of gratitude sight (AGS) because it helps you find things for which to be grateful. Whenever you encounter a serious problem that you must find the will to face and overcome, you can use this sight to focus your awareness on things for which you are grateful. Indeed, in any problem situation, the first thing that you want to focus on is not the problem itself, but rather that which you are grateful for in the moment. It will give you a clear awareness with which to make a good decision. You will find that one of the problems that you will need to regularly use it for is waking up in the morning to face a new day.
Search for Contraband
As we are entering a secure institution, one where an artificial culture must be maintained against active resistance to its imposition, there are certain things that are restricted. Yes, we are going to have to search you prior to entering. You will not be allowed to take in certain things with you. Lucky for you, we are going on a descriptive tour and not a physical one. In the descriptive tour, you will be allowed to keep your cell phone, shoelaces, and keys. However, you will be searched for ideas that could pose a security risk to the DC. Namely, you will be required to put aside many of the narratives on which you rely to make sense of reality.
Many of the assumptions that we take for granted in The World could pose a security risk to the maintenance of this artificial culture. Indeed, they may give inmates ideas that the staff do not want them to have, and so you cannot bring them inside. You are literally entering a different world.
List of Contraband Ideas
Equality or egalitarianism is not permitted within the DC. The DC must maintain a strict class division based on inequality. All humans are not created equal while in the DC. Those who can leave are equal and those who cannot are inferior to those who can leave.
Your understanding of morality is not permitted while in the DC. While general notions of morality may inform subsequent micro-narratives created within the DC, you will have to leave your morality behind. The new task you will have is simply this: saving your own life. That is, you will have to convince the class of those who can leave to release you, otherwise you will die a slow, miserable death in the DC. You will watch your life wither and die slowly over decades as you are drugged into submission day in and day out until finally your body quits and you die. You will look out your window and see The World, but never be able to participate in it unless you are released. So, trust me leaving your morality here may save your life.
Your sense of humor cannot come inside. Do not worry, you will find a new sense of humor while you are inside. It will still be uniquely “you” in that it will arise out of your personality. However, you may find yourself laughing at things that you would not find funny in The World. Once again, trust me, this too may help save you.
Your own self-image and how you believe that you relate to The World are not permitted. Maybe you are a doctor, lawyer, researcher, teacher, or store clerk. You have developed an image in your mind of who you are; you could call this your identity. This identity cannot come inside. However, you will be able to develop a new identity that comports with the available micro-narratives present in the culture of the DC.
Your sexuality cannot come inside either. I know, it is a major aspect of your life and identity. It is also a source of happiness and bonding with other humans. You will be assigned a new sexuality that will save your life, if you can adhere to it. Whether you like it or not, agree with it or not, you are now asexual. Trust me, this one is important and will save your life. If you try to sneak your now “contraband” sexuality into the DC, I am confident that you will regret it.
We will be entering a forensic psychiatric DC, sometimes referred to as a “hospital.” Indeed, these DCs are accredited by hospital accreditation commissions. Do not be distracted by this. This is not a hospital like the one that you went to when you had to have your tonsils removed. This is a DC, period. I have seen people struggle with this to their disadvantage. Holding onto your current understanding of a “hospital” will diminish your ability to successfully navigate—and ultimately survive—a treacherous and divisive culture. Ultimately, your life may depend on you letting go of the idea that these places are “hospitals.”
The expectation of privacy is not allowed inside. There is no room for privacy. You will have to be OK with strange people knowing you better than you feel comfortable with. You will need to learn to live with these people whether they are inmates or staff. You will also get to know some people more than you want to know them. Furthermore, the privacy of information enshrined in the Health Insurers Portability and Accountability Act (HIPAA) will be largely irrelevant in these so-called hospitals.
You will quickly see how important the free flow of certain “private” information is for the maintenance of an artificial culture, especially for a liaison. Fortunately, as you will have the perspective of an inmate, HIPAA will not apply to you, as it only applies to staff. As I give you a guided tour of a forensic psychiatric DC, I will use privacy in accordance with how a liaison and the staff would use it. That is, when it is strategic to conceal information, privacy can be invoked in a micro-narrative. However, if it is strategic to share otherwise private information, then I will do so.
Great, now that you have been issued your equipment and searched for contraband ideas, let us depart on our journey. In this journey I will present various themes and related accounts out of chronological order. This presentation allows for the best understanding of real life inside a forensic psychiatric DC. We will essentially hop around time to explore various themes. Buckle up and secure your inner guidance system, strange nostalgia binoculars, true vision goggles, reality-proof vest, standard issue weapon, and attitude of gratitude sight, as it will be a bumpy ride. In the first account, we will explore the ground where death and life meet, and you will be shown why you were not allowed to bring your morality on this journey.
Each account will be accompanied by a briefing and debriefing. Not only does this support the military conflict narrative being applied, but more practically, it will allow you to discover important concepts prior to and after each account. They are intended to give you a deeper appreciation of each account. Furthermore, what you learn in any briefing or debriefing may be applied to other accounts. The series will be presented as if you, the reader, are embedded with me in a zone of active human conflict. You go where I go and do what I do, and you will survive just like I did. As you read this series, always remember that no one knew how the future would play out as the events were happening and that I was not guaranteed survival and a “happy ending.” One false move and I may very well have ended up stuck in the DC for life.