Behind the Gates of Gomorrah: A Year with the Criminally by Stephen Seager

By Stephen Seager

A darker twist on Orange is the recent Black, this actual insider's account supplies an eye-opening look at the nation’s biggest state-run forensic clinic, a facility that homes the real-life Hannibal Lecters of the world.

Psychiatrist Stephen Seager was once no stranger to locked psych wards while he accredited a role at California’s Gorman kingdom clinic, identified in the community as “Gomorrah,” yet not anything may have ready him for what he encountered while he stepped via its gates, a triple sally port at the back of the twenty-foot partitions crowned with shining coils of razor cord. Gorman kingdom is likely one of the nation’s biggest forensic psychological hospitals, devoted to treating the criminally insane. Unit C, the place Seager used to be assigned, was once reserved for the “bad actors,” the mass murderers, serial killers, and the real-life Hannibal Lecters of the world.

Against a backdrop of surreal beauty—a verdant campus-like environment the place peacocks strolled the grounds—is a spot of outstanding violence, a spot the place a small employees of clinicians are anticipated to control a unstable inhabitants of prison-hardened ex-cons, the place lone therapists lead sharing circles with sociopaths, the place a bootleg underground financial system prospers, and the place sufferers and physicians frequently degree their lives in line with how briskly they could run. To go in the course of the gates of Gomorrah is to go into a looking-glass global, the place the trimmings of the traditional calendar yr exist—Halloween dances and yuletide events (complete with visits from Santa), springtime softball groups and basketball leagues, yet marked with paroxysms of brutality (Santa is going berserk), and peopled by means of figures from our nightmares.

Behind the Gates of Gomorrah provides an eye-opening glance inside of a facility to which few humans have ever had entry. sincere, rueful, and from time to time darkly humorous, Seager’s gripping account of his rookie 12 months blends memoir with a story technological know-how, explaining either the aberrant brain and his personal, from time to time incomprehensible, selection to stay in a task with a perilously steep studying curve.

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If EBM, as the current definition reads, attempts to integrate a variety of factors in clinical decision-making such as clinical expertise and patients’ values without defining integration, couldn’t anyone who says that they considered these factors argue that they were engaged in evidence-based practice, regardless of what decision was made? How can this be meaningfully distinguished from the kind of practice that existed prior to the emergence of EBM? In fact, when participants were queried on this point, across all groups they pointed to the application of research data from properly conducted clinical empirical research in accordance with the evidence hierarchy as the important distinguishing feature between pre-EBM and evidence-based practice.

Users’ guides mentions a ‘4S strategy’ (systems, synopses, summaries, and studies), using slightly different definitions from Evidence-based medicine. Systems are again at the top, but are defined in the way that Evidence-based medicine defines summaries. Synopses are defined in the same manner. Ranked next are summaries, which are defined as Evidence-based medicine defines syntheses. Original studies are ranked last. Critically appraising individual studies was the hallmark of the EBM approach in its beginning, but after 20 years of evolution its texts now rate original studies lowest as sources of evidence.

Am I asking any clinical questions at all? 2. Am I asking focused questions? 3. Am I using a map to locate my knowledge gaps and articulate questions? 4. Can I get myself unstuck when asking questions? 5. Do I have a working method to save my questions for later answering? Step 2: finding the best external evidence 1. Am I searching at all? 2. Do I know the best sources of current evidence for my clinical discipline? 3. Do I have easy access to the best evidence for my clinical discipline? 4.

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