5 Terrifying Truths of Working with the Criminally Insane

We had minimal self-defense training in a setting where I would have vastly preferred "maximum." Those in charge almost went of their way not to train us. I was told that if we were given self-defense training, we'd be legally liable if something went wrong. In other words, "We can't train you because then you could use it." Instead we were told, "Well, simply stop fights before they start."

With ... psychic powers? Prayer? Time travel?

Prevention isn't always possible when you're dealing with people who are there specifically because they don't act rationally. We do get trained in deescalation techniques, and they can be incredibly effective. But they don't help when someone's already erupted, at which point our training boils down to "Fuck it! Run!"

Not only is that not ideal, it's not always even possible. In one incident, a resident chased a staff member around the dining room with a mop. Because of the layout of the room, my colleague's sole option was to hop back and forth over a counter that was attached to the wall. It was like a terrifyingly high stakes Looney Tunes cartoon. The solution to prevent this absurdity in the future? Move the counter.

That shit's so laconic that it's downright Spartan.

At this point, you're probably wondering why we don't apply all of our fancy social work education to diffuse situations. The answer is that we have little to none of that -- the qualifications needed for this job are even less impressive than our training. This started as a summer job for me during college. A guy told me I could make $10 an hour, and I said, "That sounds better than Arby's!" (In fairness, literally everything is better than Arby's.) If you have a high school diploma and the ability to pass a background check, you too can be responsible for crazy murderers!

But staff members also knew how to set a resident off just enough for a doctor to order seclusion. So if someone started getting on our nerves on a Friday afternoon, we could get under their skin in turn, make them respond, and report the incident. They'd get ordered into seclusion until Monday because the doctor wanted to spend all weekend playing Xbox without interruption.

I'm not proud of it, but sometimes we did it because we knew the resident was on the verge of assaulting someone. And other times, they got locked up because they were annoying us. We're still human, and sometimes humans suck.

Because of stuff like this, mental health advocates are working to eliminate seclusion. They have nothing but the best of intentions, and maybe they're right. But my residents were not quirky folks in there because they call flowers by their first names -- they're criminally insane. The second part of that term doesn't totally negate the first.

Have you ever imagined how a homeless man pleasures himself? What am I saying? You're on the Internet. You've not only imagined it, you've looked it up and made a shitty pun in the comments section of the Reddit thread about it. Well, you can take the homeless out of the masturbator, but you can't take the masturbator out of the homeless. Our residents masturbated everywhere, often and with great creativity and enthusiasm. Some would even call us to their rooms under false pretenses so that we could admire their ability to strangle the cyclops.

One day while we collected the trash, a resident held out a banana peel and proclaimed "I fucked this!" with a sense of pride normally reserved for showing off your newborn child.

Something about mental hospitals seems to drive people into a lustful frenzy. At night, residents are locked in their rooms, but there's a little door that can be unlocked to pass them food or whatever. If someone were to squat, that door would be at crotch level, and you can connect the dots from there. I worked with a woman who was caught on the surveillance camera positioning herself in front of the door juuust right. That's embarrassing enough on its own, but it's not like the cameras were hidden. Part of her job was to monitor them. She had to know she was going to be caught, but apparently the only thing sexier than a bad boy is a criminally insane boy.

Then the kid got arrested again because he had stopped taking his medication. The relapse cycle is depressingly common. Sometimes residents don't even make it to trial before being readmitted. When a resident is found competent they go back to county jail to await court. Jails can't force them to take their medication, so they might stop and regress to the point where there's no choice but to send them right back to us.

But you can't let all the failures get you down, or else you won't be able to enjoy the progress. I've worked with people who have gone from uncontrollably smearing their shit on the wall to stable human beings who are fully in control of what shit they smear on which wall. It's truly moving.

For more insider perspectives, check out 5 Horrifying Truths About Being a Medical Doctor and 5 Harsh Truths You Learn as a Doctor in the Third World.

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