Inside A Forensic Psychiatry Unit: Rolled Ankles, RATs, and Invisible Abuse—The Final Obstacles Toward Freedom

Editor’s Note: This is the eighth 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 are committed to finding our freedom. However, that task will not be so easy. The challenges that we must overcome to secure our release are by far the most intense of them all. We will be expected to be 110% mindful of our thoughts and surroundings. We will need to summon all our strength to surmount formidable attempts to sabotage our chances at freedom.

Briefing

For this scenario, you will need to be informed that RATs does not refer to vermin, but rather stands for Reasonable Activity Therapists (RATs). Although, be advised that we may encounter vermin as we traverse the DC. Don’t worry, the RATs and the fictional narrative of a yet-to-be-discovered brain disease are far more challenging than furry little creatures searching for scraps of food. Finally, we will encounter an unspoken and largely invisible tragedy that affects most, if not all, inmates who enter into any detention center (DC), especially a so-called “mental hospital.” This invisible tragedy is inevitable sexual abuse, which can take various forms. In this scenario we will learn about the mild and extreme ends of the sexual abuse spectrum.

Scenario

The one “treatment activity” that appealed to me and that I can say that I found helpful was physical exercise. This is often referred to as “activity therapy” in the DC, especially when a paid employee facilitates the exercise. When working out independently of paid staff, exercise was considered a “leisure activity,” not treatment. These exercise sessions, which may include basketball, soccer, softball, and weightlifting, were facilitated by RATs.

The RATs earned their name by generally being the most laid back and reasonable of all the treatment professionals. The term RATs is also fitting due to the staff’s allegiance to other staff. That is, staff will “throw inmates under the bus” quickly and easily if the inmate disrupts the status quo too much, including staff-inmate power relations. Only vulnerable people and fools would believe that staff would risk themselves to protect an inmate, even if the inmate is the victim of sexual abuse and the staff have legal obligations to protect the inmate from such abuse.

Sex and power are complex and closely related in The World. The relationship between these two phenomena is exponentially more complex in the DC. Sex leads to power and power leads to sex. Furthermore, sexual impulses do not disappear with a status of “involuntary detainee” or “treatment professional.” Indeed, in such a close quarters environment that is full of tension, anxiety, and sadness, sex is as prized as it is shunned.

That is, despite the state-level statutes outlawing staff-inmate sex and facility policy banning inmate-inmate or staff-staff sex, it nevertheless pervades the culture. Furthermore, it is a criminal offence for a staff to have any sexual contact with an inmate, as the inmate is not considered capable of giving consent while they are an inmate.

Despite all of this, one of the most sought-after roles for an inmate was that of a “sex slave.” Inmates were deprived of all sexual contact (whether married or not) with all people for the entire duration of their detention. No, there are no conjugal visits for acquitted mental patients. There is most certainly no touching or sexual innuendo. The modern field of mental health has come about as far from Sigmund Freud as possible. To Freud, libido was at the foundation of mental issues. To the modern mental health professional, libido is an inconvenient reality that they can pave over with the fiction of a brain disease. Desiring a woman is treated like a symptom of an underlying brain pathology in the DC. Eugenics persists in the modern mental health system.

Even if not explicitly articulated, the corollary of this mentality is that mental patients just do not breed; only staff can breed. Such extreme control over other people’s sexualities is just another tactic of control in the DC. It results from the ongoing class struggle between those who can leave and those who cannot. Forcing someone to not use their sexuality, and then punishing the manifestations that do break through is a mild form of sexual abuse that all inmates are subject to.

In other words, in the DC, sex is seen not as sex, but as power. In controlling the sexualities of the inmates, their power is controlled. Perhaps this is partly why the role of sex slave was so valued by inmates. If they could use their sexualities to “flip the power script” and exert some degree of control over their staff sex master, they might stand a better chance at survival—that is, if the sexual abuse does not destroy them first.

One of my favorite activities was soccer. It allowed me to forget about where I was for 90 minutes or so. When I was “in the zone” it did not matter where I was, I was just having fun. Soccer was managed by two RATs. The younger RAT, who was my age, we will call Miss Andry. She was well known among inmates for being both an attractive young woman and one who loved to control male inmates.

At times she would commit a grave offense to any inmate in a DC: she talked to adult males as if they were young children. Inmates were then justified in keeping their distance from Miss Andry as, “she talks to us like we are kids.” It was for this reason that I intended to keep relations between Miss Andry and I on good terms. The other RAT was an older woman, close to retirement age, who did not have such misandrist tendencies. We’ll call her Blind Eye. While Blind Eye’s vison was normal, she was an expert at “turning a blind eye.”

While Miss Andry was certainly cute, I decided early on in my stay that I would not get involved with sex, whether with staff or inmates. As Elgin Mental Health Center (EMHC) was co-ed, male-female sexual relations between inmates were an ongoing issue. So too was male-male and female-female sex. While I definitely desired sex, I chose the path of a monk. I saw that sex and power were just too intertwined to be able to predict what might happen.

With what I already knew of staff-inmate power relations, my predictions were always negative. That is, when I considered how I might fulfill the role of sex slave, I always had the sense that things would just not work out as my hormones wanted them to. Moreover, the culture at EMHC was such that any instance of “sexual acting out” in my medical record could mean a Socially Acceptable Death (SAD) for me. That is, such chart notes were treated so severely that I may end up spending decades rotting in the DC, trying to secure my freedom with but a single negative sexual chart note. When it came to secretive sex in the DC, the saying “failure is not an option” is to be interpreted literally.

Miss Andry and Blind Eye were generally more reasonable than any of the treatment professionals that I had to deal with on the unit. They seemed to see us as more human. They were also less educated than other professional staff. That is, they only needed an appropriate bachelor’s degree and not a master’s or doctoral degree. As such, they were also low on the workplace totem pole.

Their mentality facilitated the inmates’ ability to forget about the harsh realities of life in the DC while exercising with the RATs. Furthermore, as Miss Andry and Blind Eye were not RATs assigned to my unit, they were able to interact with me without having to be concerned with what my unit staff might think.

Miss Andry and Blind Eye recognized that I and numerous other inmates were not at all symptomatic. Rather, we were just trying to survive an unjust DC which refused to follow its own policies on releasing inmates. As such, Miss Andry and Blind Eye would routinely expect inmates to report any injuries themselves, unless so obvious that they would get in trouble for not reporting it.

Recall that EMHC is technically a “hospital”, and each staff owes a duty of care to inmates. Essentially, Miss Andry and Blind Eye would assess whether a particular inmate was capable of understanding the nature of their injury and taking appropriate steps to remedy it. It was a rather paternalistic role. Fortunately for me, I had amassed considerable power as an inmate and RATs would generally defer to me on whether I needed to report an injury.

Reporting injuries was a complex phenomenon, which may be why RATs were reluctant to strictly adhere to rules. If an inmate reported an injury, they could be restricted from attending all activities for an extended time period. This could range from weeks to years. Exercise was integral to surviving the DC.

Reporting an injury on behalf of an inmate without their consent could substantially alter power relations. The staff could create animosity between them and the inmate. Furthermore, such animosity could extend to other inmates or to other staff. That is, what can begin to occur is that after a power adjustment, one “in-group” may ostracize another. For example, if Miss Andry or Blind Eye reported an injury without my permission, I could get my inmate friends to ostracize both of them and, in retaliation, they might target my entire in-group.

While there are more manifestations of power adjustments than I can recount in this essay, this should serve as a good example of how complex power adjustments can get.

The Grooming Period

I made my physical health a top priority while in the DC. This protected me from getting injured or sick. It also helped me to acquire power by maintaining an indirectly intimidating physical presence. Muscles mean a lot in the DC! I was incentivized to avoid injuries as there had been too many horror stories of injured inmates who came back from surgery with unintended damage.

Specifically, inmates were generally sent to medical students at the University of Illinois at Chicago (UIC). There, we were given the “honor” of playing Guinea Pig for medical students practicing to become real doctors. If they messed up and the inmate was left with another injury, the treatment team could then step in to threaten the inmate out of suing UIC. That is, botched medical procedures were protected from liability by convincing the inmate that they would be detained longer if they filed a lawsuit. RATs knew this complexity and were reluctant to report injuries on behalf of inmates.

Around 2016, I managed to roll my left ankle significantly while at soccer. It was bad enough that I had to hobble around. I still could exercise, and I had no intention of reporting this obvious injury. I continued to play soccer and basketball, but I took a more reserved role during the games to protect my ankle. A few weeks later, I rolled my right ankle. Now, I did not even have a good ankle to put my weight on. Nevertheless, I continued my exercise routine without any changes beyond adjusting my role during the game. Perhaps I would play defense instead of offense as this required less running. At this point I could not even run, but only hobble around with two rolled ankles. Each step was excruciating, but I would not allow myself to be an experiment for UIC medical students. I knew that if I could still walk, eventually my ankles would heal. Miss Andry and Blind Eye never reported my injuries and while I am glad that they did not, an even bigger challenge awaited me.

I could tell that Miss Andry was interested in me and she would interact with me to gauge how I felt about a sexual relationship. I was being groomed to be a sex slave! I struggled with this opportunity as I had been detained for almost 15 years at this point. I did not overtly refuse Miss Andry’s advances, especially as such a refusal alone could disrupt power relations. I either had to accept her advances or think of a clever way to say, “Hell no!” without her being fully cognizant of it.

Around this time, Miss Andry decided to put words aside and use her body to express how she felt toward me. As she was naturally good at soccer and I was athletic myself, we kept things in balance by being on opposite teams. I was the de facto captain as everyone at soccer told me to “make the teams” as soon as I arrived. I would routinely put Miss Andry and I on opposing teams. One day, Miss Andry took this opportunity to rub her body against mine while we were both going for the ball in a corner of the gym. At first, I did not think much of it, as we were playing sports and such accidents can happen.

However, in subsequent weeks, Miss Andry continued to do this every opportunity she got. The ball would go into a corner, she would chase it and use her body to protect it. Then I would follow and stop short of touching her. She would then extend her hips backward to rub her buttocks against my groin. While a single incident may be an accident, repeated incidents are something different.

I went along with this as I did not know how to deal with the situation. Saying something to Miss Andry could easily prompt a major adjustment in power relations. Furthermore, as an inmate, I recognized that I would be scapegoated in the event that I accused her of misbehavior. As this contact occurred with clothes on, I allowed it. That does not mean that it did not have its adverse effect. I developed a simultaneous attachment and aversion to soccer. I loved the exercise and the touch of a woman felt relaxing. However, I also recognized that this little sexual game we were playing could easily get out of control. She could advance further on me, blame me, or a little of both.

As weeks and then months went on like this, it became so expected that both Blind Eye and other inmates would make overt comments. This was not so much to deter us, but rather to advise us that we had been spotted and that we would need to be a little more secretive if we wanted to advance the relationship. Such comments were used to redirect a horny staff-inmate couple to be a little more aware of their surroundings and a little less focused on hormones.

The reality is that legal obligations are so strict in the DC that the slightest error in reporting can result in a criminal offense for staff. This can be a little unrealistic for the culture of the DC as sex is just so common. If staff reported every single instance of “suspected sexual abuse” of inmates, the office that investigates such claims would be overwhelmed and managing the DC would become impossible. This is because when sexual abuse is formally reported, it triggers certain actions the staff must take, like separating the staff from the alleged victim. If this happened regularly, there would be no stability in the facility culture. Indeed, the culture of the DC is allowed to remain relatively stable because staff repeatedly turn a blind eye toward suspicion and overt instances of sexual abuse. This in no way justifies the failure to report by staff; rather, it shows that some serious reforms of our national mental health system are desperately needed.

For quite some time, Miss Andry said little or nothing when her behind was pushed up against me. At times she would make sexual innuendo, but that was the extent of our talking when she was expressing herself physically to me. After several months and numerous comments from other inmates and Blind Eye, Miss Andry shifted course. I followed her into the corner one day and, after an inmate said, “You two get a room,” she said loud enough for that inmate to hear, “get off of me.” While she was the one who was on me, I nevertheless seized this opportunity to begin distancing myself from these interactions. She was at fault but blamed me. By this point, it was time to either advance the relationship, or terminate the sexual component.

I saw that Miss Andry was too eager to throw me under the bus. I avoided her in the corner at this point and would even put her on my team more often to minimize the possibility that we would touch like that again. I slowly tip-toed out of this and was able to preserve my power relations with Miss Andry. I think that we were both seriously considering advancing the relationship, but it became apparent that it would have been utterly impractical to continue the sexual component. After months of mild sexual abuse, I extracted myself from that toxic relationship and was able to do so “cleanly” so that I did not incur retaliation from Miss Andry or Blind Eye.

My ankles had healed, and I successfully exited a dangerous sex slave “grooming period.” However, not all inmates were as perceptive to the realities of a sex slave relationship. Indeed, a sex slave relationship requires such a major power adjustment that there may be “collateral damage” when such an illicit relationship goes awry.

The Collateral Damage

Around 2017, rumors had abounded throughout EMHC that a young black male inmate was acting as the sex slave for a much older white female staff. Despite an entire culture of “turning a blind eye” to illicit sexual activity, the female social worker in this situation was escorted off the premises by EMHC security and placed on administrative leave around the end of June 2017. Rumors abounded that there was a very serious investigation going on. Furthermore, these rumors asserted that there was even an audio and/or video recording of sex acts between the social worker and inmate. Of course, as inmates, we sought access to these recordings. If they were made public, society could see for themselves how toxic and abusive EMHC really was.

I and other inmate advocates who had little or nothing to lose began to ask around to find who had the recordings. At the time, inmates were allowed personal computers, so long as they could not connect to the internet. Files were routinely exchanged on flash drives and if we could find the inmate in possession of the recording, we might be able to use it as leverage to secure our freedom. Little did we know that staff were searching for this recording too.

It should have been obvious to us as inmates that if we valued the recording for how it could help us secure freedom, staff were incentivized to find it to assist in covering up the incident. The fact is that the victim was scheduled to be unconditionally released by mid-July. In Illinois, we have limits to forensic detention that extend to the maximum time that one would have received as punishment had they gone to prison. For me and my three attempted murder charges, my Theim date (as it is called in Illinois) was around 2052. For the victim in the recording, this Theim date was only a few years as his case was relatively petty.

What happened soon after was one of the most heart-wrenching things I have ever seen. The inmate was 100% the victim. It did not matter whether he liked the sex or wanted it. He was not capable of giving consent while detained. This is an appropriate way to understand inmate-victims of “custodial sexual abuse.”

EMHC staff apparently conspired to convince the inmate that he was to blame. They treated him as if he had broken the law and restricted him to the unit; prevented him from calling most family and all friends except his mom; all his property was confiscated; and he could only receive visits from his mom under strict circumstances. EMHC Administration (ADMIN) had most likely decided that if the inmate was discharged with the impression that he escaped punishment, he would not report being raped. Indeed, ADMIN was successful with this to a certain extent. The inmate was discharged in mid-July 2017 and thought that he was at fault, and he felt terrible because of it.

Upon the victim’s release, ADMIN began a major assault on all inmate “troublemakers.” That is, several inmates were suspected of intending to use the recordings to tarnish the reputation of EMHC by revealing the truth to the taxpaying public. We were prepared for retaliation, and it came in full force.

As an inmate-advocate I was accustomed to retaliation. However, this degree of retaliation was extreme. The day the victim was released, ADMIN sent about 10 uniformed security guards to my room to search it for “contraband.” They seized all my electronic devices and assured me that they just wanted to “check them” and they would promptly return them to me. This was a lie.

All my previously approved electronic items had been confiscated and ADMIN was dragging their feet answering my questions on the status of the “checking.” I imagine that looking through entire hard drives, flash drives, and mp3 players in search of recordings of sexual abuse requires time. Strangely enough, ADMIN only kept the devices of the troublemakers. They returned the electronic devices of “compliant” inmates within hours. I was accused of possessing numerous items of “contraband” which consisted of items that were previously approved and which I had for years without issue.

This occurred on a Saturday morning. By the time the work week came, I witnessed or heard rumors of numerous room searches throughout the DC. Most inmates had their items returned later that day. However, a handful of “the usual suspects” had the items confiscated indefinitely. My interpretation was that ADMIN zeroed in on the inmates that they felt could cause damage to their reputation if they had the recording. Furthermore, ADMIN appeared to “make us into an example” for compliant inmates. Actions like this sent chills down the spines of nearly all inmates, but especially those who were targeted. It could significantly disrupt the status quo of informal power relations in the DC. Both inmate leaders and their sympathetic staff were on edge because of this. Both groups had vested interest in preserving the informal status quo.

As the workweek progressed, my treatment team had meetings with ADMIN in the unit conference room. They were discussing what to do about me. I am confident that ADMIN had meetings on other units for other inmate troublemakers. By Thursday of that week, I was called into the conference room for a meeting with my treatment team, but not a single member of ADMIN. My treatment team had been actively working toward my release. Indeed, earlier that year, they secured “grounds passes” from my judge in a court hearing. However, at this meeting, they acknowledged that their hands were tied, and that ADMIN insisted that they punish me. They brought obviously false accusations that I had contraband (i.e., previously-approved personal property); that I violated HIPAA (federal privacy law which an inmate cannot possibly violate); and that I neglected my duties as Inmate Council Secretary (by distributing copies of publicly-available lawsuits against EMHC).

For these reasons, they illegally restricted me. They restricted my court-approved passes, my facility-approved pass, my right to visitation, my right to personal property, etc. Essentially, they violated numerous Illinois and federal statutes to restrict anything and everything they could. When I left the meeting, I could pretty much only eat, sleep, and use the toilet, indefinitely.

During the meeting, I advised my treatment team that the restrictions being placed on me were so unusual and severe that I had never witnessed anything like it in nearly 15 years of detention. I went on to advise them that I had good reason to treat this as a case of “abuse and neglect.” The very accusation of abuse or neglect by an inmate or staff triggers reporting requirements for staff. In other words, the moment I told staff this, they could face criminal liability if they did not in turn report it to the Illinois Office of the Inspector General (OIG) within four hours. I cleverly put them in a quagmire where they had to balance the interests of ADMIN as well as their own personal liability.

That afternoon, just prior to an outdoor softball game run by the RATs, I was called into the conference room again. This time it was just the unit’s Nurse Manager. She explained that she had not been at the earlier meeting as she was in a different meeting with ADMIN. She told me that the treatment team “misspoke” and that the only things restricted were the two court-approved passes I earned in early 2017. This made the situation go from extremely bad to a tolerable. I did not use the court-approved passes that much anyway as there was so little that inmates could do with them besides smoke cigarettes, and I did not smoke.

However, without reinstating those passes, the judge would never grant my freedom. I had to “demonstrate responsibility” to the court by using the passes from time to time. As they were restricted, I was essentially stuck indefinitely. This meeting did restore numerous other “in-house” privileges and rights that were taken from me earlier that day. The meeting with the Nurse Manager occurred less than four hours after the initial meeting. I doubt that anyone “misspoke”; rather, I obstructed the insidious plans of ADMIN, but still took damage in the process.

The following day, about 10 uniformed security guards came to my cell not to search me again, but to force me to pack my belongings. I was being moved against my wishes and those of my treatment team to another unit, one with a very “pro-psych drugs” psychiatrist in charge.

Upon arrival, I quickly strategized on how to get back to N unit. I used my “going cyclic” strategy to write as many legitimate complaints as possible. While on N unit, I had kept certain issues silent to not disturb power relations with staff. However, once forced to this new unfriendly unit, I let loose. I likely wrote about 20 well-worded complaints that weekend. By the time Monday came, ADMIN had more legitimate complaints that they could handle.

I was in a position to disrupt the status quo of staff as my own status quo was disrupted. ADMIN did not realize that I had saved some complaints out of respect for certain staff in my SHIELD defense. With my SHIELD gone, I could say what I wanted without thinking too much on how it would affect power relations.

ADMIN decided to move me back to N unit by Tuesday. At that point, things began to settle, but I had to deal with hopelessness again as I could not move forward until my passes were restored. This process would take time. Months later, the top administrator, Dr. Emperor, came to my unit to evaluate me. He found that there was nothing wrong with me and this paved the way to return my passes in early 2018.

By mid-2018, my attorney filed a petition for my release. I was able to avoid last ditch efforts at sabotaging my release in part due to the total lack of sex-related chart notes in my record. You see, my judge was eager to release me as he could see years of stable behavior. However, Dr. Emperor saw a final chance.

It was no secret that I was “monkish” while at EMHC. I successful suppressed sexual impulses for years and my record reflected this. No one could make the case that “sexual inappropriateness” was part of my symptomatology. However, Dr. Emperor tried to play the flip side of this to spite me. By 2018, I had been detained for nearly two decades, all without normal sexual interactions. While always appropriate, Dr. Emperor tried to assert that my lack of sexual inappropriateness was itself an issue. For obvious reasons, this did not go far.

He tried to assert that prior to returning to The World, I needed to live on a co-ed unit for several years to demonstrate that I knew how to interact with females. This was so absurd it was laughable. Only a deranged mental health professional would reinterpret such a good thing as a treatment issue that needed to be fixed with indefinite detention. Even Dr. Emperor had his limits. No matter how much psychobabble he used, he could not convince other staff that my lack of sexual chart notes meant that I needed more detention. I avoided another transfer to a co-ed unit with a very “pro-psych drugs” doctor in charge.

This paved the way for my release, and I was granted my freedom in spite of Dr. Emperor’s behind-the-scenes efforts to sabotage this.

Debriefing

Sexual abuse is inherent in any DC. On the mild end of the spectrum, inappropriate touching can have long-lasting effects. I currently am uncomfortable with human touch that is even remotely sexual. While this is improving, my current sexuality is the result of iatrogenic damage. In addition to the advances of Miss Andry, I spent nearly 20 years getting “patted down” and strip searched by hateful hands, among other forms of sexual abuse that are beyond the scope of this essay.

I witnessed normal and mild expressions of sexuality by other inmates result in extreme punishment. Telling a female staff that her hair looks nice could result in significant restrictions. I generally avoided such “innocent” male-female banter.

Then there is the extreme end of the spectrum in which inmates are raped. This may be in the form of a sex slave, or just outright rape. Here, the inmate has little recourse as staff routinely turn a blind eye and the inmate is confined with or at the hands of the rapist. Whatever form the sexual abuse takes while in the DC, you can be confident that it is an inherent aspect of the culture in any DC.