Inside a Forensic Psychiatry Unit: Earning the Right to Sleep on the Floor

Editor’s Note: This is the third 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.

Our objective in this scenario will be to earn the right to sleep on the floor.

Briefing

After years of sleeping on surfaces that were inappropriate, I developed severe and possibly permanent back pain. You see, in order to make the nightmarish forensic psychiatric detention center (DC) a “friendlier” place, the Illinois Department of Human Services (IDHS) decided to use prison industry mattresses that included specific instructions on the tag indicating that the mattress was intended to be used on a hard flat surface, such as a slab of concrete—like what would be seen in a prison.

However, because forensic psychiatric DCs are not prisons, but rather “hospitals,” what would outside inspection and accreditation agencies think if they walked through Elgin Mental Health Center (EMHC) and saw inmates sleeping on mattresses on concrete slabs? They might see through the veil of illusion momentarily and figure out that this place is more like a prison than a hospital. So, instead, the mattresses were used on a strange spring mesh that I have never before seen which allowed your body to sink into it unevenly. This meant they were actually worse for our backs.

However, life in the DC was far too complicated for me to be able to just listen to my body and sleep on a thick yoga mat placed on the floor. Instead, I had to deal with micro-narratives which could be used to accuse me of being symptomatic because I chose to alleviate my severe back pain in that way. Thus, to realize our objective of sleeping on the floor, we will have to first construct an appropriate micro-narrative that will allow us to do so without the possibility that it will be misconstrued as “symptoms” of so-called mental illness.

In order to successfully construct the appropriate micro-narrative, we will need the knowledge of hegemonic conflict. This type of conflict is a unique type of human conflict in which control over others, including one’s opponents, is realized through consent. That is, in hegemonic conflict, the goal is to get others to consent to what you want or need them to do. While the tactics used in hegemonic conflict may depart from traditional human conflict based on the use of injurious or deadly force, the underlying struggle for life in the face of destruction remains. Thus, to attain our goal of constructing a micro-narrative to allow us to sleep on the floor, pretty much anything that would convince others to consent to our objectives is on the table.

In this scenario, we have just been transferred from Hartman Unit to M unit in a surprise move by the EMHC Administration (ADMIN). This was a desperate attempt to prevent my use of the Mother of All Tactics of Hegemony (MATH). What is the MATH you ask? It is a tactic of hegemonic conflict so powerful that people are only informed on a “need to know basis,” and for this scenario, you simply do not need to know. It’s an integral part of the next piece in this series, so you’ll be briefed on it then.

I assure you that it is so powerful that ADMIN saw my intent to use it and quickly moved me to another unit. However, this panicked move by ADMIN was one of their greatest blunders in their apparent attempt to hit me with a Socially Acceptable Death (SAD).

Scenario

Historically, M unit was where EMHC put the lowest functioning inmates. These are the ones who need regular help with their Activities of Daily Living (ADLs) and who often would do either gross and/or annoying things. This could include defecating and urinating inappropriately; spitting randomly; constantly talking out loud to no one; not showering, etc. This is the unit to which I was sent. However, unlike Hartman Unit, M unit was entirely single-occupancy cells, which is ideal for long-term detention.

Upon arrival on M unit, I quickly realized that the inmates were so low functioning that I could not even socialize with them. This could be problematic if the wrong staff asserted that I was “not socializing” or that I “was isolating.”  This could be construed as symptoms of so-called mental illness. In some cases, staff would try to use what they thought was inadequate socializing with other inmates as justification to label an inmate with Antisocial Personality Disorder (APD), which has little, if anything to do with a lack of socializing with others with whom there is no common ground.

APD is used in The World for people who were rebellious as youth and who, as adults, continue to violate the rights and respect of others without remorse. It is not appropriate for adults who just can’t find common ground with other adults who defecate in their pants daily. However, the insidiousness of this diagnosis is that once given, it takes on a life of its own.

To survive M unit and defend against an APD diagnosis for choosing to not talk to inmates who refused to shower regularly, I got into the habit of talking to unit staff. These were mostly the nurses and Security Therapy Aides (STAs) who were responsible for managing daily life on the units. As time went on, I developed strong rapport with nearly all the unit staff (although this did not include the treatment team). It was then that I discovered ADMIN’s blunder.

Becoming a Liaison        

As you may recall from the first essay in this series, staff have an incentive to find and elect a liaison to make their job easier. As those on M unit were so low functioning, it did not have a liaison when I arrived. It was probably the only unit without one.

Prior to this point in time, I had never been a full liaison. However, I had learned much from many years of observing the subtle power dynamics of life in various DCs. I had previously risen from “just another inmate” to consistently being the sidekick to unit liaisons.

M unit was the ideal time and place for me to finally be “elected” as a liaison. After a month or so of socializing with the nurses and STAs, I became seen as the inmate who “ran M unit,” which is one way to express my status as a liaison. As I was now friends with nearly all the unit staff, they wanted my assistance as an inmate to help them manage other inmates. Also, since the other inmates were so low functioning, they just acquiesced to my power as a liaison as it was given to me by staff.

There is an interesting dynamic within the DCs managed by IDHS. The “lower” unit staff are those who occupy positions that do not require advanced degrees. The STAs needed only a GED and the nurses could have merely an associate’s degree. Staff on the treatment team and ADMIN required advanced degrees like master’s or doctoral degrees. Therefore, the subtle class divisions present in The World remained at their workplace. In other words, the “lower” unit staff were subject to an education-level based power division. As such, there could easily be friction between these “lower” staff and the treatment team and ADMIN. They were ideally positioned so that I could use hegemonic tactics to get them to consent to defending me against the treatment team and ADMIN.

In my conversations with staff, I would get regular briefings. As I was now a liaison, I was expected to assist in shaping the culture of M unit. This meant that information was provided to me on a “need to know basis.” Privacy laws did not matter here. If staff determined that I, as a liaison, needed to know private information about another inmate or workplace news, then I would be told.

One of the things that I found out was that ADMIN did not just transfer me out of the blue to M unit, but that they were also actively spreading negative gossip about me to M unit staff, both “lower” staff and the treatment team. Specifically, I was told that ADMIN said that I was “difficult to deal with” and that I was a “troublemaker.”

I am confident that this gossip was being spread to aid in the construction of micro-narratives against me by M unit staff. While the treatment team tended to believe these lies, the “lower” unit staff were able to see the real me, which contradicted much of what ADMIN was saying about me. This actually had the effect of helping me to gain the consent of these “lower” staff.

Ultimately, the disinformation spread by ADMIN backfired terribly. As a result, I was able to construct a defensive hegemonic tactic that I will call “Staff Hinder Interference, Effectively Limiting Destruction (SHIELD). The SHIELD tactic was based on creating a “buffer zone” between ADMIN and I. ADMIN was not in a position to micromanage daily life on the unit (even though they tried!) and instead depended on unit staff acquiescing to the micro-narratives created by ADMIN for controlling the unit.

These micro-narratives were so powerful that they could direct daily life. Indeed, the gossip being spread about me to M unit staff was an example of this. ADMIN likely hoped that the unit staff would run with these micro-narratives and make my life difficult.

My SHIELD defense, though, was so effective that ADMIN lost a great deal of control over me and the culture of M unit. The unit staff simply would not implement directives coming from ADMIN, in general. For example, ADMIN created a facility-wide policy limiting the number of personal food items that one could access during two daily 15-minute snack times. M unit staff knew that due to various factors, including my high level of physical activity, I consumed around 4000 calories a day while maintaining an athletic build.

When this policy was initially announced, I complained, as EMHC provided me with only about 2200 calories daily. Even this figure does not reflect the reality of the situation, however. I would frequently not eat everything provided to me, as EMHC refused to give me a 100% vegan diet despite my request.  This meant that I was living with, at best, a daily 1800 calorie deficit, unless I could eat enough of my own food to compensate for this.

As 4 personal food items in a day could not amount to 1800+ calories, M unit staff simply refused to implement the facility-wide policy and all the inmates on M unit were generally able to continue consuming as many of their personal food items as they chose. This is also an example of how a liaison benefits the entire culture, as other inmates were happy to be able to continue eating what they wanted.

After earning my status as a liaison, I was finally in a position to sleep on the floor. With my SHIELD defense, the unit staff were protecting me from intrusive micro-narratives that could disrupt the unit culture and my own path toward freedom. The “lower” unit staff were the ones responsible for doing “face checks”; that is, regular rounds where the staff account for all inmates. It was these face checks, which occurred every 30 minutes, that were the threat to sleeping on the floor. If one of the unit staff came past my room and saw me sleeping on the floor, without the appropriate micro-narrative to justify this, I was vulnerable. However, after becoming a liaison, I was in a position to construct my own micro-narrative and my status as a liaison gave me the power to get unit staff to consent to it.

Prior to actually sleeping on the floor, I made sure to notify the “lower” staff in the course of our conversations that I planned to sleep on the floor and that this was due to my severe back pain. Once I felt that the micro-narrative was adequately constructed, then I was able to transition to sleeping on the floor. I was able to sleep on the floor from about 2012 when these events occurred until I was released in 2019. Over time, the micro-narrative that I created with the help of my SHIELD defense became so powerful that no staff, including ADMIN, were able accuse me of being symptomatic for sleeping on the floor.

By the end of my detention, most staff generally avoided discussions of me sleeping on the floor as it might have obligated them to give me a proper surface on which to sleep.

It is important to understand that micro-narratives must take hold in the mind of people in order for them to be effective. Thus, just because two staff believe that I am sleeping on the floor due to severe back pain, this would not necessarily protect me from the influence of other micro-narratives. However, with a broad enough consensus, the micro-narrative would be considered “common knowledge.” So, while my initial goal was to be able to sleep on the floor to relive my pain, I could not stop there. I needed to ensure my long-term protection from ADMIN and the treatment team to not just sleep on the floor, but also to earn my release.

With my SHIELD up, I was now in a position to engage with the treatment team. While the “lower” staff refused to believe the gossip spread by ADMIN, the M unit treatment team ate it up without question. I was now in a position where I was generally protected as a liaison by the “lower” staff while actively engaging in a conflict with the treatment team and ADMIN.

Getting off the BDTs

One of the objectives that I needed to pursue long-term was getting off the Brain Damaging Therapeutics (BDTs), also known as psych drugs. When I arrived on M unit, I was in stealth ditcher mode despite the fact that the psychiatrist ordered my pills crushed. However, I did not want to be in this position for release. You see, the BDTs gave me numerous painful side effects, including akathisia, insomnia, constant hunger, among others. They also interfered with my ability to navigate my own subjectivity. That is, I was still recovering from so-called mental illness and the BDTs made that task harder, not easier.

As they adversely affected the acuity of my awareness, my standard issue weapon, I found it more difficult to determine reality from fantasy while taking them. As this did not comport with the narratives present surrounding BDTs in a forensic psychiatric DC, my cries for help were ignored and I was coerced onto BDTs.

Also, if I were to get released with a court order requiring BDTs, I could get sent back to a DC if the courts found I was ditching the BDTs. Knowing me, this was almost inevitable.

My attorney advised me that if I really did not want to take the BDTs that I should be honest with the staff. In Illinois, inmates have a statutory right to refuse treatment, including BDTs. So, with the help of my attorney, I was able to openly refuse the BDTs. This mostly impacted the treatment team and ADMIN, as the “lower” staff were already accustomed to dealing with me as a liaison.

While the “lower” staff were surprised by my open refusal, within a short time period my relations with them went back to normal, as they dealt with me regularly as a liaison and saw no changes in my thinking or behavior. Indeed, they were unaware that I had been ditching the BDTs prior to my open refusal (so I knew that there would be no noticeable changes in my behavior). I recognized that it was only a matter of time before the staff in my SHIELD figured this out.

Normally, when an inmate openly refuses BDTs, all the unit staff, including the “lower” staff, participate in attempts to construct micro-narrative to coerce the inmate back onto the BDTs. In my case, sleeping on the floor would have been an easy target. I could see the construction of a micro-narrative that somehow linked not taking BDTs as the sole cause of sleeping on the floor. This is why it was important to apply the SHIELD defense and openly refuse BDTs prior to actually sleeping on the floor.

Since I was the liaison, “lower” staff had little incentive to participate in the construction of these micro-narratives, as it could have interfered with the smooth functioning of their own workplace. As the power in the unit culture rested on inmates and “lower” staff, the treatment team by themselves were impotent to interfere with my status as a liaison. Even though treatment teams had significant power in the DC, they were so outnumbered by inmates and “lower” unit staff, that they could not control the culture of the unit without the consent of “lower” unit staff. In this case, they did not have that consent.

My social worker at the time, whom I will call Ms. Madea (think of Tyler Perry’s character), was accustomed to dealing with the low-functioning inmates of M unit. She was totally unprepared for dealing with me. As the treatment team staff were formally educated, they would easily underestimate inmates. Recall from the first essay that, in The World, the narrative that forensic inmates are “dangerous people in need of medical model psychiatric treatment” is useful to justify the ongoing detention of an inmate. But this narrative is useless for understanding how to navigate the DC. Ms. Madea got stuck on this narrative to her disadvantage.

While I have no reason to believe that she was anything but a good family and community member in The World, she was an opponent (opps) to me while I was on her caseload. To be clear, I did not begin by seeing her as opps, as I was incentivized to get as many staff on my side as I could in the construction of my SHIELD defense. However, in retrospect I was opps to her as soon as I walked through the door of M unit, most likely because she believed the disinformation generated by ADMIN.

I came to see staff like Ms. Madea as bullies who utilized hegemonic tactics. They would play on the ignorance of inmates to gain their consent for various things. However, I was not the typical low-functioning M unit inmate. The following is a depiction of a conversation I had with Ms. Madea.

MADEA: I want you to resume taking your medication. It is important for your recovery.

ME: I am not going to do that as the drugs interfere with my ability to think clearly, plus they give me unpleasant side effects.

MADEA: Mr. Gunderson, I am surprised that a smart young man such as yourself did not know that we have medications specifically for side effects.

ME: Umm, that is partly true. You do not have a panacea for all side effects. You can offer anti-Parkinson’s drugs like Cogentin that help to reduce the tremors and stiffness associated with Tardive Dyskinesia (TD). However, as I do not have Parkinson’s disease, I have a major problem if I find myself taking Cogentin.

MADEA: OK, well side effects or not, your medications are like insulin for diabetes as you have a brain disease. You need to be on them to remain stable, and definitely to convince the court to release you.

ME: Can you show me the evidence that supports your assertion that mental illness is the result of a brain disease?

MADEA: Once again, I am surprised that a smart man such as yourself did not realize that mental illness is the result of a brain disease.

ME: I did not disagree with you, I simply asked for evidence to support it. Please find it for me so that I can develop even better insight into my mental illness.

Ms. Madea never provided me with evidence showing that so-called mental illness is a brain disease. Had I not been adequately informed of my own so-called mental illness, then Ms. Madea could have easily backed me into a conversational corner where I would either acquiesce to her demands or look irrational for not going along with her. She was essentially trying to construct micro-narratives and use me and my presumed ignorance in that process.

Perhaps she had hoped that I thought that the anti-Parkinson’s drugs would alleviate all my unwanted side effects or that I would have been unable to properly counter her assertion that so-called mental illness is a brain disease. She had laid two traps for me in this conversation, either of which could have led to her ability to construct a micro-narrative to paint me as in need of the BDTs.

It is worth noting that so-called mental illness cannot be outright denied in the DC. This would lead to an accusation that one “lacks insight” and could lead to the construction of a micro-narrative to justify increased levels of coercion. The indirect way to question the epistemological validity of so-called mental illness was to innocently ask for evidence. The staff had internet access and we did not. Thus, I could feign ignorance and ask for evidence, which was never provided in 17 years of detention.

As time went on, I sensed that Ms. Madea, who was close to retirement, was becoming increasingly frustrated with me. This was dangerous for an inmate as she had the power to make false accusations against me. She was an unpopular social worker among inmates on M unit as she would “break” the resistance of some inmates with her clever conversational tactics. She was so effective that she was able to get some inmates to voluntarily store their soap and hygiene supplies in a locked closet. I was not one of those inmates. I was not going to go along with such an absurd demand that seemed to be done primarily to test the acquiescence of some of the inmates on her caseload.

Treatment team and ADMIN staff would often gauge the appropriateness of inmates for release based on how easily they acquiesced to any and all demands placed on them. Apparently, developing total dependence on mental health authorities is considered a sign of health under the medical model. If you cannot pee without having to ask an authority figure, then you must be ready for release. Indeed, other inmates and I would regularly laugh at low-functioning but highly compliant inmates who would get recommended for release by their respective treatment teams despite an almost objective inability to manage their own lives.

No matter how hard Ms. Madea tried, she just could not break me. She did not understand how powerful I had become as a liaison.

Ms. Madea Breaks

I would need my SHIELD for one of my final interactions with her. I was in Ms. Madea’s private office. I had already begun to feel a little uncomfortable in private with her as I had no other staff to verify what transpired. It was apparent that Ms. Madea was going to continue using tactics to get me to acquiesce to her demands. Indeed, as one tactic failed, she would come back and try again with another. I was concerned that she would eventually resort to fabricating things to use against me in the construction of micro-narratives.

In our final private interaction, I was so offended with her tactics that I got up and left her office. I did this entirely appropriately, but I nevertheless terminated the meeting. She lost total control, as resisting her should not have been as easy as saying, “Ms. Madea thank you for your time, but I am going to go back to my room now and read a book.”

I exited her office in the corner of the dayroom, and she got up and walked after me rather quickly. In fact, when I looked back, she was right behind me with her hands raised in the air with fists clenched. Upon noticing this, I found a nearby table in the dayroom and proceeded to run circles around it to keep the table between her and I. She proceeded to chase me around the table in an apparent attempt to catch me. As she was running around the table, she was yelling, “I’m not crazy, you’re crazy, you’re the one with the mental illness!” It is worth noting that I never overtly accused Ms. Madea of being crazy, so she was responding not to me, but rather to thoughts in her own mind accusing herself of apparently mentally ill behavior.

I could tell that Ms. Madea had broken down mentally. While I hesitate to characterize her behavior as “mentally ill” due to my ideological disagreements with that terminology and my lack of knowledge as to her own history, I can say with confidence that her move was a hegemonic blunder.  She did not realize how many people were actually watching us, and how stable and calm I remained throughout the entire situation. As I was running circles around the table with Ms. Madea yelling at me, numerous “lower” unit staff and inmates witnessed this. It was clearly a “reportable” offense according to Illinois statutes regarding abuse and neglect of inmates in forensic psychiatric DCs.

Staff are mandated reporters, which means that they must notify the IDHS-run Office of the Inspector General (OIG) whenever there is an event of “suspected or actual abuse or neglect.” As she did this in front of other unit staff, they were upset with her because she put them in a position where they had to make a choice to follow the law and report her actions or ignore it and lie to OIG if it did get reported. With so many witnesses, it was likely that someone would report this to OIG. Indeed, I did.

This was a major issue at the time, as it involved three different stakeholders in the construction of M unit’s culture: the unit liaison, “lower” staff who comprised my SHIELD, and a member of the treatment team. All three exerted significant power and mediating this while preserving the culture was no easy task.

Almost immediately, staff from my SHIELD empathized with me. Later that day, they also briefed me that they chastised Ms. Madea for being so overt with her out-of-control behavior. I was briefed that she told staff that “her patience with me was wearing thin” and that she, “did not like dealing with me.” My SHIELD was in an awkward position as staff were being called upon to both protect me from dangerous micro-narratives and protect Ms. Madea from an OIG investigation. During these briefings with various staff who witnessed the situation, I got them to acknowledge to me that they saw what transpired and how inappropriate it was. However, as I recognized the delicate power balance present here, I did not expect them to tell the truth to OIG.

Staff would regularly coordinate with each other to “get their stories straight” before OIG came weeks later to investigate. As such, OIG was practically useless for inmates. Instead, what usually happened was that staff would get their stories straight and make it appear as if the inmates just made up the accusation. OIG would investigate and usually return a finding of “unfounded” which is defined as “no credible evidence to support the accusation of abuse or neglect.”

This was rather extreme considering OIG could have returned a finding of “unsubstantiated” which is defined as “credible evidence exists to support a finding of abuse or neglect, but such evidence does not exist in a preponderance.” In other words, when OIG concluded that my allegations were “unfounded” they were in effect saying that nothing even happened, or worse, that I made it up. Perhaps the fact that “unsubstantiated” findings allowed access by the accuser to the investigative records generated in the case and “unfounded” findings had no such access is the reason why so many inmate complaints to OIG were “unfounded.”

I did not care so much about getting Ms. Madea fired, which is the required result for any allegations of abuse or neglect that are “founded.” I just wanted to get off her caseload, which is exactly what happened days after the incident. With my SHIELD defense up, and out of a toxic relationship with my social worker, I was now able to focus my attention on more important matters, like getting transferred to M unit’s sister unit, N unit.

N unit was a normal unit in that it contained a balance of high-, middle- and low-functioning inmates. Also, as the sister unit, the treatment team was different, but the “lower” staff were the same as they rotated between the two. Thus, I would be able to keep my SHIELD defense and make progress toward my freedom.

Debriefing

It is imperative to understand hegemonic conflict in order to appreciate how I was able to secure my freedom against all odds. In principle, hegemonic conflict retains the same life and death struggle present in traditional warfare; however, the tactics used must seek to control others, including opps, through consent. Hegemonic conflict does not seek to overcome resistance using brute force, but rather uses various social strategies to realize objectives.

This unique type of conflict can be conceptualized as a real-life chess game. The narratives and micro-narratives present in the DC serve as parameters of the chess board on which hegemonic conflict plays out. Using hegemonic conflict as a conceptual tool to understand my journey, I can see that my transfer to M unit was a blunder. ADMIN did not appreciate the significance of the role of a liaison and essentially handed me liaison status.

My status as a liaison was a smooth and natural outcome of being housed on a unit that did not already have a liaison due to other inmates being too low-functioning to occupy the role. So, while ADMIN may have believed that they were controlling me by putting me on M unit, it had the opposite effect. My time on M unit laid the foundation for my release a number of years later, as I retained my status as a liaison and my SHIELD defense until I was released in 2019.

Indeed, there was a certain “Art of Hegemonic Conflict” which I employed and of which ADMIN was unaware.