Inside a Forensic Psychiatry Unit: Access to the Courts—A Right and Survival Tool

Editor’s Note: This is the fourth 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.

In this scenario we have arrived back at Elgin Mental Health Center (EMHC) after being extracted from Chester Mental Health Center (CMHC). This rapid extraction occurred because I had just written a letter (with the help of my parents) exposing the corruption at CMHC to various Congresspeople, news media outlets, and mental health advocacy agencies. The office of one state-level Congressman had been in contact with my mom, assuring her that I would be transferred back to EMHC quickly. I had been informed the Friday before Labor Day, 2011, that I would be transferred back to EMHC and, indeed, that Tuesday I returned to EMHC.

Briefing

Our primary objective will be to practice using the Mother of All Tactics of Hegemony (MATH). Recall from the previous scenario that the MATH is so potent that it is classified information. Information about the MATH is shared on a “need to know” basis, and in this scenario you need to know about it. The MATH is a lawsuit, and the version that we will be learning about is a pro se lawsuit, which means that we will have the responsibility to assemble and use the weapon ourselves. We will not have the luxury of having an attorney do it for us. It is important to note that whether pro se or represented by an attorney, the MATH retains its great power.

We will arrive into the custody of a rather malicious treatment team. If we get stuck in their custody, it could mean death in the form of a socially acceptable death (SAD). Our first stop will be Hartman unit, which is one of the most dangerous units due to the treatment team present on that unit. Be extra careful for the rapid and unexpected construction of micro-narratives that can paint even the most normal behaviors as “likely psychotic.”

Due to the dangerousness of the treatment team on Hartman unit, it is best to minimize interactions with them, without being suspicious by appearing to avoid them. Instead, we will need to figure out a way to get transferred to another unit, which is not an easy task. While inter-unit transfers are possible, they are rare and are generally realized only when appropriate micro-narratives have been constructed so that the transfer makes sense to everyone involved.

As we learn how to bring a pro se lawsuit, be sure to not get too excited as one cannot predict the short-, medium- and long-term consequences of its use. Expect retaliation when staff figure out that we know how to wield the MATH. It is so powerful that staff might panic and even make strategic blunders when they see you working with the MATH.

As we work toward evacuating Hartman unit (due primarily to the dangerousness of the treatment team), be on the lookout to realize a secondary objective. Hartman unit has shared cells and, as a secondary objective, we will try to arrive on a unit with single-occupancy cells (as that setup is more conducive to long-term detention).

I always put it like this: a husband and wife who love each other very much and have been married for many years still sometimes need time apart in order to keep their marriage healthy. So, if two people who love each other in a marriage need time apart, what makes you think that about 25-50 inmates in varying stages of their so-called mental illness, living in the same unit who have nothing in common except their legal status, will be continually pleasant with each other for years on end?

Somehow this common sense escapes the mental health professionals, many of whom operate under the belief that the “therapeutic milieu” is more helpful than not. The “therapeutic milieu” is a recognized form of “treatment” that is really just a euphemism for detaining a group of people on a unit in varying stages of their so-called mental illness. So, yes, sitting next to someone arguing with their own auditory hallucinations is considered “treatment.” It may not make sense in the World; however, in this microcosm of a world that is a detention center (DC), it is seen as treatment because the narrative that justified our shared legal status of NGRI meant that I must be just as messed up as the guy next to me talking to his voices.

Scenario

I arrived on Hartman unit the day after Labor Day, 2011. While it was certainly a relief to get out of CMHC and be in a less restrictive DC (and one that was closer to my family), I nevertheless got the sense that EMHC was forced to accept me back over their objections. It is never a good thing to be unwanted like I was. As they could not just release me, they had two choices: to learn to deal with me or to attempt to dispose of me in the trash of the Illinois forensic system: CMHC. I had just escaped the trash, and now I needed to keep the ground I took against the opponents (opps) who would prefer to send me back there.

As the ride from CMHC is an all-day ride, I made it onto Hartman unit just before the end of the workday. My assigned psychiatrist met briefly with me merely to renew the same Brain Damaging Therapeutics (BDT) order I had in CMHC, which was 10mg of Abilify (whole, not crushed). He said that we would discuss “my treatment” more the next day. I will call this psychiatrist Dr. Malice to emphasize this aspect of his character.

The next day, I met with Dr. Malice again, and the assault that I had been waiting for since my arrival had come!

Dr. Malice took me into the unit conference room and got to work. His apparent goal was to increase the dose of BDTs as much as he could and to restart the crushed BDT order that my psychiatrist at CMHC had ended a few months prior to my transfer. Dr. Malice was very adept at the construction of micro-narratives to get whatever goal he wanted. He was the type of psychiatrist who was accustomed to dealing with mentally slow inmates whom he could “run circles around” in conversation.

While I was certainly not a “mentally slow” inmate, Dr. Malice was an effective opps who would not hesitate to construct and use micro-narratives against even the most aware of inmates. As I knew Dr. Malice would not back down, I could not falter if I expected to survive a SAD. I sensed that since EMHC really did not want me back and they stuck me with Dr. Malice, I had a SAD with my name written all over it unless I could get away from Hartman unit. The following depicts our exchange:

MALICE: I see that you have been taking your medication, is that correct?

ME: Yes, sir

MALICE: Why are you taking your medications now? I see that you have a history of ditching them.

ME: Because I recognize their long-term value for getting conditionally released and ultimately returning to my family.

MALICE: I would like to increase the dose of your Abilify.

ME: I do not understand why you would want to tinker with my medications, I am doing so well. They advised me in CMHC to tell the treatment team to not change my meds within the first 2 months. They said that most inmates who come back do so because the treatment team at the receiving facility changes their meds soon after transfer. How about we let me get situated here at EMHC for a couple months and revisit this conversation?

MALICE: That’s good that your treatment team told you that, but you are my patient now and I do not feel comfortable with having you on a subtherapeutic dose while you are under my custody. You have a history of violence and if something happens, then that will reflect on me.

ME: Well, I think the point of why they said that is because any changes in medication can lead to instability.

MALICE: I doubt you will become unstable with a 5mg increase, and if you do, we can deal with that if it arises.

ME: I would like to stay on the 10mg, thank you.

MALICE: Are you resisting my recommendations for treatment?

ME: No, sir, I am just trying to play it safe by not trying to fix what is not broken.

MALICE: Well, if you do not go along with my recommendations, I can take you to court, and we will see what the judge has to say.

ME: OK, fine, I consent to 15mg. Can I go now?

MALICE: I would like to talk with you about something else.

ME: What is that?

MALICE: How long have you been off of a crushed medicine order?

ME: About 2 months. I have been taking my meds the whole time as evidenced by my ongoing stability.

MALICE: Well, you have a history of violence and I do not feel comfortable with you off of a crushed order.

ME: Yes, however, I proved to my treatment team at CMHC that I could be responsible enough to take my pills as prescribed.

MALICE: I want you to be on a crushed medicine order while you are under my custody.

ME: I would prefer to stay off of it.

MALICE: That’s great that you proved to the treatment team at CMHC that you could be trusted to take your meds, but now you are at EMHC and I am asking you to prove to us that you can take your meds and the only way to start that process is to accept a crushed medicine order.

ME: OK, I can go along with your request, but can we set a timeframe for this? That is, can we make specific attainable steps for me to follow that allow me to build trust with my treatment team here at EMHC? I do not think that I could get conditionally released if I was not even trusted to take my meds as prescribed.

MALICE: You know what, this meeting is over. I need to check the referral system to see why you were even sent here in the first place…

I walked into this exchange having been ditching the BDTs for about 2 months at CMHC. I left it with a crushed BDT order on a dose higher than I was on at CMHC. I was confident that Dr. Malice’s implied threat to send me back to CMHC by “checking the referral system” would remain unrealized; nevertheless, I still had to take his threat seriously. I knew that I was sent back because a state level congressman pulled some strings and, absent overtly problematic behaviors, I would stay at EMHC. However, with the crushed BDT order and the increased dose, life at EMHC had just become a lot more difficult. Furthermore, my back pain was still severe as I had not yet earned the right to sleep on the floor.

As it turned out, EMHC was not as effective as CMHC with their crushed BDT order. Generally, I was able to ditch the BDTs despite this crushed pill order.

I quickly realized this was a hostile environment, so I did not waste time prepping to use the MATH, in case it was needed. The first step was to document everything in my medical record to support the litigation in the event that I used the MATH. I started to use pen and paper to create “personal chart notes” so that my own perspective could get added to my chart.

You see, in the forensic mental health system, the medical chart is presumed to be accurate in the eyes of the law. This is a fundamental deference given to mental health professionals, which is routinely abused in the forensic psychiatric DC. With the presumption of truth, staff can and do write anything they want in the charts of inmates. Society has essentially handed staff the power to write history as they see fit. This is one of the main tactics staff use to construct micro-narratives.

Being on a hostile unit, I knew that it was best to offer my own perspective on daily events so that if we ever made it to court, it would be a lot harder to accept as fact the staff’s words which may have been so very different from my own.

I would sit in the dayroom where all the staff could see me and write personal chart notes. I wanted them to see the power of the pen in action as we both knew the importance of uncontested micro-narratives. That is, staff were accustomed to concealing from inmates their own right to review, amend, and even add to their own medical records. Thus, they were used to writing whatever they wanted without counter micro-narratives. However, I was not going to make this so easy on them.

Within the first few days, I met my social worker, whom I will call Mr. Anger. That’s right, I got stuck with Dr. Malice and Mr. Anger as the two primary members of my treatment team—it really did not get much harder than that. I figured that EMHC did not want me and if they could get me to do or say something “crazy” enough, they could justify sending me back to CMHC. I could not give this to them.

Using my attitude of gratitude sight (AGS) I began to appreciate Mr. Anger. He had such overt anger management issues that even other staff took notice. He would have meltdowns while at work if certain things did not go his way. I was so grateful that he gave the inmates a legitimate justification in the context of the micro-narratives present to not trust him. That meant that I could commiserate with the Security Therapy Aides (STAs) about Mr. Anger. STAs were low-level non-uniformed security staff who managed daily life on the units. These were not professional staff; indeed, most had minimal education, such as a high school diploma or GED.

Within the first week of my arrival, I had a confrontation with Mr. Anger, which is depicted in the following exchange:

ANGER: Do you need me to do anything for you today in my capacity as your social worker?

ME: Yes, I have several personal chart notes that I would like you to file in my chart.

ANGER: Let me see them.

[I hand Mr. Anger several handwritten documents and he proceeds to skim them]

ANGER: I do not know if I can add these to your chart; your chart is only for medical records.

ME: Yes, I am aware that these are not documents produced by staff, but I assure you that it is appropriate to add them to my chart.

[He hands the documents back to me]

ANGER: Listen, I cannot just accept your word as a patient.

ME: I am familiar with the statutes regarding this, and I was doing this regularly in CMHC.

ANGER: I am not going to file these papers in your chart until I can confirm that it is legal to do so.

ME: I understand. Give me about 2 minutes and I can dig up a copy of the law that says that you have to file these in my chart. Trust me, I have been doing this for a while now.

ANGER: There will be no need for that, I can find out on my own.

ME: Here, just take the documents, make me a copy, and add the originals to the chart, please.

ANGER: Listen, Sean, I am not going to take these papers from you at this time.

ME: I know that when you check on the legality of this, you will find that you actually have an obligation to file these documents in my chart. So, let’s save some time as you are a busy man and just take the documents. If you get them back to me later today, tomorrow, or next week, it’s all good.

ANGER: Don’t you understand what I have been saying?! I am not going to file these documents at this time! I’m the staff, you’re the patient, you do what I say!

At this point, I realized that Mr. Anger was not going to take the documents from me, and he was beginning to throw a tantrum. I did the only sensible thing that one grown man could do to another who was throwing a tantrum just like a little child: I began to laugh at him.

ME: Dude, are you serious? It’s not that big of a deal. At some point you will read the statute that I have already read and that CMHC staff were aware of when they filed personal chart notes for me, you know all of those notes handwritten by me that are already in my chart. How do you think they got in there in the first place?

ANGER: If and when I find the statute you are talking about, I will get these documents from you, goodbye.

While I did not get the documents filed that day, I did get plenty of gossip to tell the STAs about. He would come back in a few days to file the documents for me. In retrospect, due to the gossip it generated, it was probably more useful in the long run that he threw a tantrum and later filed the documents than if he had behaved like a professional and just filed the notes then and there!

If Dr. Malice and Mr. Anger were not enough, I arrived on Hartman unit to an active MRSA infection.

In the first week after I arrived, one of the STAs clued me into the severity of the MRSA problem by showing me a list with two columns that had about 15 names on it. The first column was “confirmed” the second was “suspected”. There were about 2 suspected inmates for every 1 confirmed. This STA told me to be careful and protect myself as the facility did not intend to protect me or the staff from MRSA.

Meeting Paul O.              

I met an inmate, Paul O., soon after I arrived. Paul O. was an interesting character. First, he was the liaison of Hartman unit; he had lived there for years and had adequate influence over the culture. Second, he was as “high functioning” as one could get: he did not even have a diagnosis of mental illness. Paul O. was an Unfit to Stand Trial (UST) inmate who represents the epitome of the abuse of that legal status. Paul reported that EMHC administrative staff (ADMIN) told him that he was “fit the day he arrived.”

You see, Paul was caught in a corrupt scheme to give him a SAD. He had been accused of a sex crime against a minor as a minor (when he was 17). While I do not know the events that transpired to lead to his arrest, I am confident that if the case was as “open and shut” as the narratives surrounding his legal case paint it, then the prosecution would have simply taken him to trial and let a jury convict him.

However, this is not what happened. Instead, Paul reported catching the prosecutor and his defense attorney at the time tampering with evidence. At that point, they sent him for a “psych eval” which found him “unfit to stand trial,” thus effectively preventing a trial that Paul had originally wanted as he was confident that a fair trial would result in his acquittal. He was said to have “delusional legal reasoning” and apparently psychiatric treatment could fix this.

As he had not been previously diagnosed with a mental illness, he received a “diagnosis” of pedophilia, which is a valid DSM diagnosis. While not appropriate to use to justify a UST legal status, its loose relationship to “mental illness” allowed certain public officials in his case to construct a narrative in court records that he needed to be sent to EMHC to “restore his fitness.” Put simply, Paul was not mentally ill but found himself there as a result of corrupt public officials trying to cover up something.

Luckily for me, he was familiar with the court system and knew how to wield the MATH. We began to strategize together, as he quickly realized how valuable of a resource I was to have on the same unit. We began working toward using the MATH together in a joint strike operation among numerous inmates. We were going to file a multi-plaintiff pro se lawsuit in the federal courts to compel EMHC to deal with the MRSA to ensure the safety of both inmates and staff.

Paul was restricted to the unit by Dr. Malice at the time and he had me going to the library to type up various documents related to the filing of the pro se lawsuit. I quickly became a popular inmate with the STA staff as I was a high-functioning friend of Paul, the Hartman unit liaison. As they were responsible for the day-to-day activities, I had no issues getting signed out to go to the library to work on legal documents, despite my tenuous relationship with Dr. Malice and Mr. Anger.

I needed these protections from staff as EMHC put great effort into obstructing inmates’ rights. After all, how could an inmate realize and enforce their rights if they were unaware of them to begin with? EMHC had no law library or person trained in the law to assist inmates in preparing and filing legal documents, despite abundant case law requiring them to do so. Essentially, they were illegally preventing inmates from realizing their right of “access to the courts.” Indeed, I only learned about this right in 2010 while in CMHC, about 5 years after being in the Illinois Department of Human Services (IDHS) as an NGRI inmate.

I would go to the library and type up various documents, and I would try to conceal the content of these documents from any staff who might get wind that I was trying to work toward filing a lawsuit. After a couple of weeks, we began to submit a coordinated campaign of complaints that were serving as the precursor for a lawsuit. Paul and I agreed that if we could remedy the MRSA situation without a lawsuit, it was ideal.

Paul acknowledged to me that as a liaison, he was being pressured by STA staff to “do something about the MRSA.”  That is, the STA staff did not feel comfortable working in such conditions, and so they went to the unit liaison to try to change the unit culture. Paul and I saw that a lawsuit or at least the threat of it would instigate change, not only making the unit safer for inmates and staff but also adding to the headaches for ADMIN. Paul’s best hope for release was using legitimate means to aggravate ADMIN so much that they would work to send him back to the court system so that he could have his trial or otherwise get released. ADMIN hated complaints and hated lawsuits even more.

Less than a month after I arrived, one of the lead STAs who had grown to like me came to tell me that I was “moving to M and N unit.”  What a joy to hear those words! I was going to get away from Dr. Malice and Mr. Anger. That prospect gave me hope to be optimistic over the future. Hope is important to help inmates get through the long and arduous days.

The newer units at EMHC, built around 2000, were two-module pairs, such as M/N or K/L. All the newer units, including M/N, had single-occupancy cells. I began to feel hopeful that I would finally be able to construct the necessary micro-narratives on M/N to earn my right to sleep on the floor.

The STA told me that she did not know the reason for the transfer, except that ADMIN had ordered it. EMHC policy did not allow for ADMIN to initiate transfers except in emergency situations. Rather, the treatment teams on the units had the responsibility to coordinate inter-unit transfers. ADMIN did not care about policy; after all, they wrote it. ADMIN would routinely transfer inmates according to their whim, even over objections from the inmate and/or their treatment team.

So, while I was happy for the transfer, it was also ominous as it meant that I had the attention of ADMIN, which almost guaranteed that they would try to micromanage me through the unit staff, including the treatment team.

I tried to find out more about this transfer, as there was a substantial difference between M and N units.  N unit was a normal unit with a blend of inmates. There were some low-, mid-, and high-functioning inmates on N unit. I hoped that I would go there. I knew that M unit was different. While many of the same staff that worked on N unit also worked on its sister unit, M unit, the culture was very different. M unit was reserved for the lowest functioning inmates in the entire DC. While this designation was unofficial, it was nevertheless populated by numerous inmates who could barely hold a conversation with another human being; frequently defecated or urinated on themselves; and who slept their lives away in BDT-induced hazes.

As it turns out, I was sent to M unit. In retrospect, I believe that I was sent to M unit to isolate me and to prevent me from coordinating with other inmates like I did with Paul. ADMIN saw how quickly I made waves with Paul and sought to obstruct this. M unit was desolate in terms of human interaction.

Yet, I still felt that this move was better than being on Hartman under Dr. Malice and Mr. Anger.

Debriefing

Obstruction of access to the courts is a key strategy to control inmates and make the culture in the DC an easier workplace for staff, especially ADMIN. It was no accident that I discovered the MATH about 5 years after I arrived in IDHS custody after my NGRI verdict. Perhaps one of the reasons for concealing this information from inmates was to promote the narrative that staff are truly helping the so-called mentally ill and that there is no abuse going on. A lack of court decisions in favor of inmates helps to support the “presumption of correctness” narrative that is at the heart of legal doctrine surrounding mental health law.

Once again, we find a narrative that is excellent for justifying the ongoing detention of forensic inmates, but that fails in its ability to help us understand real life in the DC. A “presumption of incorrectness” is more useful for helping one to navigate and ultimately survive the DC. Between the “presumption of correctness” and control of the flow of information, it becomes relatively easy for staff, like Dr. Malice, to construct any micro-narrative they want.

ADMIN can and will use laws, policies, and rules at their convenience for their advantage. They recognize the power that is given to them by society in the form of the “presumption of correctness” and they will generally use it to realize their own objectives of having inmates acquiesce to medical model ideologies. It becomes easier to see this when one is in a relationship with ADMIN that creates friction. This friction reveals so much information that we can consider it a tool to use throughout our journey. It is “friction radar” (FR). That is, the friction-causing relationship shows the true intentions of the ADMIN instead of allowing these intentions to hide behind the presumption of correctness.

Indeed, this presumption of correctness is a form of camouflage on a hegemonic battlefield. Our FR allows us to see the actual position of our opps despite the camouflage. For example, I found out that ADMIN’s “official” reason for my transfer to M unit was to prevent one of my peers from taking advantage of me. This referred to Paul and my conscious and voluntary efforts to help him file a lawsuit to deal with the MRSA. However, my FR showed their position to be a little different. My FR indicated that they moved me to limit both Paul’s and my own ability to use the MATH.

While I may never know what ADMIN was thinking when they transferred me, it is worth noting that in many cases the usefulness of a thought is reflected in its ability to further an objective. Thus, the thought that ADMIN moved me to prevent Paul and I from using the MATH is a functional thought, regardless of its truth value. That is, I can continue to build my strategies around it and, if my strategies work, then the thought was effective. I try to avoid the “true/false” dichotomy while in a zone of active hegemonic conflict, as sometimes the truth may never be known.

In retrospect, the thought that I was transferred to obstruct access to the courts was far more useful in the long-term than the micro-narrative that EMHC had some treatment duty to “protect” me from the undue influence of a peer.