Behind the Gates of Gomorrah: Treating the real-life Hannibal Lecters of the world

WHAT makes some people commit horrendous crimes? Psychiatrist Stephen Seager has spent decades treating the criminally insane. Here he reveals the horrors he’s seen.

Actor Anthony Hopkins as Hannibal Lecter in scene from film 'Red Dragon' - movies

EVER wondered what makes some people commit truly horrendous crimes?

American psychiatrist Stephen Seager has spent decades trying to find the answer to that question. Seager spent years working in Unit C at California’s Napa State Hospital, known locally as Gomorrah, treating the criminally insane.

Seager has interviewed some of the worst mass murderers, rapists, serial killers and real-life Hannibal Lecters of the world who have been deemed by a judge not guilty by reason of insanity or unfit to stand trial and he has detailed his experience and insights into the minds of these madmen in his new book Behind the Gates of Gomorrah which is on sale Jan 3.

News.com.au has been given this exclusive first look at the book which will no doubt open your eyes to what makes sick people tick.

WHO COMMITS MURDER?

On the psychiatric spectrum of disease, where exactly do mass murderers come from? Or, just as important, where don’t they come from?

They aren’t autistic. They don’t have OCD. They don’t have PTSD. They don’t have anxiety disorders, social phobia, or sensory processing disorder.

Depressed people commit suicide, not mass murder. Bipolar manic people tend to be the victims of crimes — again, not the perpetrators. They frighten people. They are often the ones shot by police. And the foil-hat-wearing, babbling street schizophrenic is too disorganised to pull off a carefully planned massacre.

What makes people commit horrendous crimes? Dr Stephen Seager believes one of the main reasons is paranoia.

So what’s left? The first troubling group is labelled “personality disorders.” A personality disorder is a persistently dysfunctional method of behaviour that doesn’t involve psychosis. The most severe personality disorders carry names like anti-social (sociopaths), narcissistic, and borderline.

While persons with personality disorders commit many crimes, including grisly murders, their behaviour and motives can be understood. These people commit crimes of passion: anger, jealousy, revenge, rage. Their murders often involve family members, spouses, or co-workers.

Their crimes may be memorable, but personality disordered people don’t commit mass murder.

This leaves one final group. And this group commits nearly all mass murders. They are the group that kills strangers, politicians, schoolchildren, theatre goers, and defence workers. They kill because they have a specific kind of mental illness. I have found that mass murderers are nearly always paranoid.

Paranoid people, usually labelled schizophrenic, may become deeply, profoundly, and fixedly delusional, but unlike most other schizophrenics — the tin-hat people — they remain organised, a fact known for centuries. They retain the ability to function, work, handle money, and plan. They can fill out government forms, amass an arsenal, produce elaborate computer spreadsheets, and implement massacres.

All paranoid persons exhibit a hallmark dysfunction, a symptom called “anosognosia,” a Greek term meaning “lack of awareness” or “denial of illness.” To a person, paranoid people don’t think they’re sick, and they cannot be convinced otherwise.

As well, paranoid people have a severely distorted view of the outside world. They universally externalise blame: “I’m not my fault, it’s them.” In an equally twisted bit of pathology, paranoid persons believe themselves to be the true victims of their conspiratorial beliefs and their actions, even of their horrendous crimes. The refrain is this: “It’s not my fault. Look what they (the victims) made me do.”

Norwegian right-wing mass killer Anders Behring Breivik arrives in the courtroom in Osl during his trial for mass killings of 77 people in Norway in 2012.

And, oddly, paranoid persons frequently display the flip side of paranoia: grandiosity. Thus they present a disturbing paradox. They say, “The government is out to get me. But I am an omnipotent god. I don’t deserve this. That makes me the real victim here. Someone must pay.” This is the reason for their committing massacres.

If mass murder is ever to be dealt with effectively, we must develop a plan for these profoundly paranoid but functional people. People who deny they’re sick; people who never seek treatment, no matter how much is offered. People who adamantly resist any type of medication or therapy. People who blame society for their troubles, believing — regardless of the horror they’ve created — that they are the true victims and that the actual victims, the massacred, “got what they deserved.”

If mass murder is to be prevented, any identification, detention, intervention, and treatment scheme must be aimed specifically at this paranoid group. New gun laws should focus on them, as well.”

TREATING THE CRIMINALLY INSANE

If anyone knows the dark depths paranoid criminals are capable of it’s Stephen Seager. In the first chapter of his book Behind The Gates of Gomorrah he remembers his first day at work inside one of America’s largest hospitals for the criminally insane.

“I arrived early for my first day of work. A remnant of centuries past, Napa State Hospital spreads over hundreds of acres in a remote valley corner, hidden from view.

Pulling onto an unobtrusive access road, I connected to Magnolia Lane, a long main drive bracketed by rows of enormous spreading elms and ornate nineteenth-century mansions. I’d just spent a full week of orientation in one of them. I recalled a lecture on the hospital’s history.

In 1872 a site was selected and work began for the creation of Napa State Hospital, one of America’s largest forensic psychiatric institutions, and one of California’s first hospitals dedicated solely to the care of the chronically insane. The doors opened November 15, 1875. From then until 1954, when the facility underwent a complete renovation, the hospital and its surrounding environs were a self-sufficient community. In 1992, with the erection of the safety fence, Napa State Hospital became a fully accredited forensic psychiatric facility and began accepting mentally ill patients remanded by the statewide criminal justice system.

Dr Stephen Seager spent years working at the Napa State Hospital for the criminally insane.

We’d been given a handout that contained the Napa State Hospital “mission statement.” It read “We promote a safe, secure, non-coercive/violence-free environment for patients served, staff, visitors, and the community.”

I turned right onto Spruce Lane, which swung by a newer administration building with a cluster of Spanish-style stucco structures behind it. These back buildings contained the “open” psychiatric units at Napa, which I’d toured during orientation. They mostly housed the older, more debilitated patients, who can come and go pretty much as they please. On a patch of lawn, I saw a group of slouched men quietly smoking cigarettes; two leaned on walkers.

“Won’t they just escape?” someone asked our instructor when we’d seen a similar crew during orientation.

“Where would they go?”

My initial appointment had been to Unit Twelve, one of these open units, until two days before, when I received a call from Dr.

Heidi Francis, the Napa State medical director.

“There’s been a switch in your assignment,” Dr. Francis said.

“You’ll be going to Unit C.”

“What’s Unit C?” I asked.

“I’ll email you a map,” she replied.

I parked in a crowded lot striped with faded paint. Pausing beside my red Toyota truck, I clipped a new orange security badge to the front pocket of my shirt and straightened my tie.

During my tenure in the mental health world, I’d been employed at many different psychiatric hospitals, but I’d never worked in a state forensic facility.

Walking slowly toward Unit C, I approached the towering “safety” fence, extending as far as one could see. The chain-link barrier stood twenty feet high. A three-foot continuous coil of razor wire ran along the top. The fence enclosed Napa State’s secure treatment area, or STA, which contained the hospital’s seventeen high risk locked units. No one stood outside smoking here. Police cars patrolled the main drives. The compound looked like a sprawling prisoner-of-war camp in a World War II movie. The STA, our orientation instructor had said, housed the hospital’s “bad actors.” New hires weren’t supposed to be assigned “inside the fence,” so I hadn’t worried much about it.

Actor Anthony Hopkins as Hannibal Lecter in scene from film 'Red Dragon' — movies

I moved toward a tall gate, which suddenly buzzed loudly. Standing beside me, an older gentleman eased the stile open and we stepped inside a monitored entryway. He closed the gate and I startled when it locked with a decisive snap.

“First day?” the other man asked.

“Yes it is,” I replied. “I’ve never really been in — ” Before I could finish, the older man pointed to my badge and we both ran our employee IDs through a reader. His name tag read “R. Corcoran.” From behind a thick glass partition, uniformed men inspected our data on a huge computer screen. As we waited, Corcoran touched my tie and shook his head. He made a fist beside his neck and raised his hand, pretending to hang himself. I whisked off the tie and jammed it into my pants pocket.

A second gate opened, behind which another pod and two new officers awaited.

“Arms up,” a compact Filipino cop said. His badge read “Bangban.” He waved a handheld sensor coil up and around my body.

“What time does the flight leave?” I said, but no one laughed.

“Pockets,” the second officer said. I removed the necktie, keys, coins, and pens from my pants pockets and dropped them into a plastic tray. Bangban eyed the tie and smirked.

“This whole business is called a sally port,” Corcoran said as we collected our loose items. I rolled up my tie and returned it to my pocket. We slipped our shoes back on.

“Sally port sounds so benign,” I said.

“They’re used at maximum-security prisons, like San Quentin,” Corcoran continued. “The U.S. Mints and nuclear missile installations.”

We entered a third inspection area. Standing in front of a thick tinted-glass window, I saw another clump of dimly lit policemen on the other side.

“That’s where they strip-search you,” Corcoran said, nodding toward the darkened pane. “Or explore a body cavity.”

Mouth dry, I glanced at the window. “Who gets searched?” I said, but Corcoran was already in front of the final gate. It hummed and we exited onto the hospital grounds.

I followed Corcoran to a final window where I was issued my hospital keys and a “personal alarm” to wear on my belt. Atop the alarm was a red button that was to be activated, we were told during orientation, in case of any “trouble.”

INSIDE GOMORRAH

The Napa State STA doesn’t fit a traditional hospital mould. A collection of one- and two-storey buildings lies in an expansive arc, like pearls on an enormous string, enfolded by the ubiquitous fence. Redone in 1954, the units echo the classic elongated ranch-style models from that era.

Each structure had been freshly painted and was well maintained. Neatly trimmed old-growth trees dotted the scene. Through it all ran an ocean of mown grass. Inside the fence, the STA looked like a college campus.

Now 77-year-old serial killer Charles Manson was found guilty of conspiracy to commit the murders of seven people. He currently resides at California State Prison. (AP Photos/California Department of Corrections, File)

Amid this verdant set piece, peacocks strutted and preened in the sun. A shimmering blue bird perched atop a cinder-block wall lifted his head and trumpeted. His call rang out in two parts, both eerily human. The first sounded like a staccato burst of laughter, the second like a person screaming for help.

As I stepped into the main building that housed Unit C, an ear splitting siren blared suddenly and a dozen strobes flashed. From doorways that lined a long corridor, people emerged at a run and began searching frantically. Some shouted. “Is everybody okay?” a large man yelled.

“Check the dining hall,” a young woman exclaimed, waving to her left, and a dozen persons surged in that direction. And still the siren wailed and lights flashed.

I stood paralysed. To my right a casually dressed, fortyish woman with short brown hair glanced at me. She fingered my ID badge.

“Are you the new doctor?” she shouted above the din.

I nodded. She reached around my hip and flipped up the depressed red button on my individual alarm. The pandemonium ceased.

“False alarm,” she called out. The throng took a collective breath before retreating back behind their office doors.

“Happens to everyone,” the woman said, and locked the main door. “Always check the red button when you get your keys. And,” she added, bending down to scoop up said keys from the floor where I’d apparently flung them, “don’t lose these. That would really be trouble.”

“It won’t happen again,” I said. “Sorry.”

“I’m Kate Henry, the Unit C manager,” she said, and smiled. “Welcome to Napa State.”

I stood for a moment in the empty hallway. From just outside the main door a distinct “ha-ha-ha” echoed up and down the concourse. It took a second to realise the sound was a peacock.

The door to Unit C was made of reinforced steel and had a small double-paned window. Inserting my key into the lock, I had just cracked the door open when a face appeared in the window.

Of the approximately 12,000 patients living at Napa State — the majority of them are rapists, killers, and mass murderers.

The wild-eyed young man had hopelessly tangled hair and wore rumpled baby-blue scrubs. He gestured frantically. “This is 88.5 National Public Radio,” he said in a spot-on announcer’s voice. “Donate to our pledge drive. Don’t listen for free, that’s stealing. Now here’s Ofeibea Quist-Arcton.” He spun three times, stopped on a dime, and flashed the familiar “jazz hands” pose before walking away.

I regained my composure and stepped fully inside the crowded hallway. A wooden chair whizzed past my left ear and smashed into the steel door like a gunshot.

Eyes red and prison muscles bulging, a tattooed white man behind me jumped to his feet from a crouch and swatted me aside. The back of my head smacked into the wall. Lights blinked. Something wet trickled down my neck.

He snatched up the thrown chair and crashed it down onto the head of a charging older black man, who crumpled into a heap. “Don’t ever f*** with me, old man!” the giant hissed, slinging the chair at the inert body. “You owe. You pay.” He backed away and walked down the corridor as a file of terrified patients pressed themselves against the walls.

He cut past the glass-enclosed nurses’ station, where a clutch of five women scattered with a terrified yelp as the big man slapped a ham like hand on the window. One nurse pushed her hip alarm and the pulsing shriek rang out again.

“Never question who’s the boss here,” the man thundered above the din, and turned to glare at me. He stood barefoot, his neck covered with interlocking black tattooed swirls, the word HELL inked into his forehead.

“The voices made me do it,” he said, and theatrically clutched both sides of his head. Pivoting on his heels, he casually strolled out toward a nearby walled courtyard. “Don’t forget to make a pledge,” NPR-man said, and scuttled behind. “Safeway Corporation will match it.”

This is an edited extract from Behind the Gates of Gomorrah by Stephen Seager (Allen & Unwin). Our Jan 3, 2014.

This is an edited extract from Behind the Gates of Gomorrah by Stephen Seager (Allen & Unwin). Our Jan 3, 2014.