Bill McCoy, with HELL tattooed on his forehead, almost knocked out Dr. Seager on his first day. NPR-man punctuates every statement with the words, "All things considered." Cervantes wears a paper Zorro mask and pink washcloths sticking out of his ears. Any of these men could kill staff or patients at any time, and they probably would enjoy doing so.

Napa State Hospital, a forensic facility, houses these people. Rapists, murderers, and terrorists reside there, some of the most dangerous criminals in the nation... with no guards. Why? Hospitals do not have guards. Most of the patients have either been found "not guilty by reason of insanity" or "incompetent to stand trial."

Seager and a team of doctors and nurses attempt to get through each day alive and with no trip to the ER. They also try to rehabilitate the patients and support each other. Alarms and calls for lock-downs regularly shriek through the facility. Shanks are a constant threat, and patients' rooms are periodically searched for such items. Toothbrushes and eyeglass steams can be sharpened into surreptitious instruments of pain and death.

Behind the Gates of Gomorrah: A Year With the Criminally Insane by Stephen Seager, 2014

In his interview on BookTV, Seager states that many people do not understand why he continues to work at Napa State Hospital. He says that there is a great staff there, many of whom return to work after being assaulted. He also cares about the patients, even though they want to kill him, since they are not able to leave the hospital. A lot of readers do not believe the events that are relayed in the book. However, Seager's editors instructed him to tone the book down. If anything, the work was desensationalized.

When fights break out at the hospital, it is often patients who save other patients or staff from aggressors because it takes the cops too long to get there.  

Some people insulated from the evil in the place have suggestions for the staff. One such suggestion was to take a drive. So Seager says, "Imagine Hannibal Lecter; put him in your backseat and take a drive around the neighborhood." I don't know if you'll finish that drive. Someone else suggested using humor. Seager's response, "The priest and the rabbi go to the store..." Dude, that guy is coming at your head with a machete! You may not finish that story. These suggestions obviously come from well-meaning folks who have probably never set foot in a forensic hospital.

After reading this book, I am very glad that I did not pursue a career in forensic psychology, which I studied at John Jay College of Criminal Justice. My patients in a psychiatric jail were murders and wife-beaters, but none of them threatened to kill me. I probably did not stay there long enough for that. There were many corrections officers there, which I was very glad to have. I believe that it is unethical to provide psychotherapy to people with antisocial personality disorder (i.e. psychopaths) because it simply allows them to better at manipulating people by adopting more sophisticated interpersonal skills.  

I visited Napa Valley as a child, and I remember sunny good weather and a beautiful horseback ride. That is a stark contrast to the images evoked by this book. Seager wrote this work as an expose; there is a culture of silence at Napa State that he wishes to crack. It is crazy that staff and patients are continually assaulted, killed and raped by patients. Effectively, nothing is done about this state of affairs. The hospital needs guards, not simply hospital police that come when summoned. 

• Stephen Seager's web site
• Author Interview on BookTV.org
• Books about criminally mentally ill persons
• American Board of Forensic Psychology
• International Association for Correctional and Forensic Psychology