The first thing psychiatrist Stephen B. Seager wants readers to know about Napa State Hospital in California, the mental institution where he treats the criminally insane, is also the most obvious: It is not a safe place.
Dubbed “Gomorrah” by hospital staff, the institution contains (just barely) some of the state’s most dangerous psychopaths: mass murderers, rapists, serial killers. On his first day there, Seager is assaulted by a patient and sent home with stitches. Despite his better judgment, he returns to work the next day, and the day after that, and after that.
Behind the Gates of Gomorrah is Seager’s account of his first 12 months at Napa State. There, violence is so regular it becomes as routine as any other banal fixture of hospital life. Group therapy sessions, Halloween dances and an inter-ward basketball league coexist with death threats, court hearings and a shiv made from the earpiece of a pair of eyeglasses.
At its best, the book gives a sense of a warped world — a place where patients are also prisoners and staff members must balance their duty to protect their charges with their instinct to protect themselves. Even the memoir’s most brutal characters offer a study in contrasts: There’s the troubled Caruthers, whose boyish vulnerability belies his lengthy criminal record, and the charming but menacing McCoy, who has killed four people but in a moment of crisis saves a man’s life.
The book is compelling as a memoir, but its forays into the politics of psychiatry and criminal justice seem forced. Rather than letting his experience illustrate his agenda, Seager constantly interrupts his story to make sure readers know what he thinks. As a result, the episodes he details lose some of their emotional and political complexity — the very quality that made them so fascinating in the first place.
Still, like a peek through the window of a psychiatric ward door, Behind the Gates of Gomorrah offers brief insight into a disturbing parallel universe. Much like Seager, readers may be drawn into it in spite of themselves.
Sarah Kaplan reviewed this book for The Washington Post.