Whispers Behind Walls: What It Really Means to Be ‘Criminally Insane’
It’s a phrase that conjures up horror movie imagery—“criminally insane.” But behind the sensational headlines and courtroom verdicts lies a world more complex, more tragic, and often more forgotten than we like to admit. These aren’t simply “crazy killers” in straight jackets. These are human beings—some terrifying, some tragic—locked away not in prison cells, but behind the heavy, unbreachable doors of maximum-security psychiatric hospitals.
So what is life really like for the criminally insane?
When Justice Meets Psychiatry: The Birth of a Hidden System
When someone is declared “not guilty by reason of insanity” or deemed mentally unfit to stand trial, they don’t walk free. Instead, they vanish into the opaque world of forensic psychiatric hospitals. These high-security facilities are designed not for punishment, but for treatment—though to many inside, it feels like a life sentence wrapped in clinical terminology.
Unlike prisons, there’s no fixed release date. The patient’s freedom hinges on whether medical staff deem them safe. And in many cases, that day never comes.
A Real Life in Limbo: Brian Bechtold’s Story
Take Brian Bechtold, a man who confessed to murdering both his parents in 1992 while suffering from untreated paranoid schizophrenia. He was committed to Maryland’s Clifton T. Perkins Hospital Center and, 30 years later, remains there.
Despite having no formal sentence, Brian lives under stricter rules than many inmates. He wakes at dawn, eats with plastic utensils, undergoes monitored therapy, and must request permission for basic activities like walking outside or using the phone.
At one point, he tried to escape by taking a worker hostage. The attempt failed. The system responded with tighter restrictions—not just for him, but for everyone.
Hospital or Prison? Patients Say It’s Both—and Neither
Unlike prison, these facilities are clinical in name. But inside, they echo correctional institutions. Razor wire tops the fences. Guards patrol with stern faces. Surveillance is constant.
Patients, however, aren’t called “inmates.” They are referred to as “residents” or “clients,” a euphemism that barely masks the lack of autonomy. Choices are stripped down to medication or restraint. Silence or sedation.
And yet, the environment isn’t static. There are therapy sessions, occupational activities, and supervised work programs. Some patients thrive. Others deteriorate in slow, invisible ways.
A Day in the Life Inside the Facility
A typical day in a place like Perkins Hospital or California’s Atascadero State Hospital starts early. Patients rise around 6:30 a.m., undergo roll call, and eat a standardized breakfast. Therapy groups may follow—anger management, cognitive behavioral sessions, or trauma processing.
Between sessions, there’s “rec time,” often limited to tightly monitored common rooms. Patients can play cards, watch selected TV channels, or talk—but always under watchful eyes.
Personal space is limited. Privacy is nearly nonexistent. Even basic tasks—like using the restroom—can be restricted, especially if a patient has previously acted out.
Medication and the Battle for Autonomy
Perhaps the most contentious element of hospital life is medication. Antipsychotics, mood stabilizers, and sedatives are administered routinely. Patients who refuse often face disciplinary action—or worse, forced injections.
Brian Bechtold, for instance, refused medication due to severe side effects. This decision cost him his privileges and painted him as “non-compliant”—a label difficult to shed in a system where compliance often determines freedom.
Is the Insanity Plea a ‘Get Out of Jail Free’ Card? Not Even Close
Contrary to popular belief, the insanity defense is used in fewer than 1% of U.S. criminal cases. Of those, only a quarter are successful. And even then, most of the defendants have long-documented mental illnesses.
Far from being a loophole, it’s a rarely traveled road that often leads to indefinite confinement—sometimes in harsher conditions than prison.
Behind the Mask of Treatment: Allegations of Abuse and Neglect
Forensic hospitals exist in legal gray zones, often shielded from the public eye. With limited oversight, these facilities have faced disturbing allegations: overmedication, isolation, physical restraint, and in rare cases, patient-on-patient violence or abuse by staff.
Former insiders, like Mikita Brottman (who chronicled Brian’s story in Couple Found Slain), speak of a broken system more focused on control than healing. While many professionals inside care deeply, they are overworked, under-resourced, and often caught in bureaucratic quicksand.
What About Release? The Myth of ‘Getting Out’
Some patients are eventually released. They enter step-down facilities, halfway houses, or supervised care homes. But many do not.
Their files stagnate. Their cases become political. And sometimes, the risk of public backlash over releasing a formerly violent person—even if reformed—becomes too great.
Patients who have served more time than they might’ve in prison remain locked away, not for what they did, but for who they once were.
Family Murders and the Mental Health Connection
The most shocking crimes often involve family. Children killing parents. Parents killing children. These “family annihilations” frequently involve undiagnosed or untreated schizophrenia and psychosis.
Psychiatric experts have long noted that these crimes usually happen during periods of delusional thinking—not premeditated malice. But the damage, of course, is irreversible. The survivors—the very patients—carry guilt, grief, and stigma for the rest of their lives.
FAQs
Is life in a forensic psychiatric hospital better than prison?
Not necessarily. While the intent is therapeutic, many patients report feeling more controlled and less human than in prison.
Can you ever be released if you’re declared criminally insane?
Yes, but it’s rare. Release depends on evaluations by psychiatrists and the legal system, and there’s often significant resistance due to public safety concerns.
Are patients in these hospitals dangerous?
Some are. Many were involved in violent crimes. However, others are non-violent and committed due to bizarre or erratic behavior.
What happens if a patient refuses medication?
Refusal often leads to forced treatment, isolation, or loss of privileges. It can severely impact a patient’s chances of release.
Is the insanity defense commonly used?
No. It’s used in less than 1% of criminal trials, and is only successful in a quarter of those cases.
Do patients receive therapy and rehabilitation?
Yes, but the quality and consistency vary greatly by facility. Some receive excellent care. Others report neglect and warehousing.
Final Thoughts: A Justice System with No Exit Sign
Inside these locked doors live stories we rarely hear—tales of trauma, recovery, violence, hope, and despair. The criminally insane aren’t always what society imagines. Many are forgotten souls, trapped in institutions that blur the line between healing and punishment.
They are reminders that when we throw away the key, we also discard the chance to understand what makes a mind break—and what it might take to mend it.