Stephen B. Seager

October 3, 2014

Stephen Seager, M.D. is one of America’s leading authorities in mental health care and the criminially insane and is a passionate advocate for the reform of the mental health care system in the United States. Originally hailing from Ogden, Utah, Seager grew up in the suburbs of San Francisco. He graduated from the University of California at Davis and received his M.D. degree from Hahnemann Medical College in Philadelphia. After working as an emergency room physician for ten years — an experience that inspired his first two books, Breathe, Little Boy, Breathe and Emergency — Seager returned to residency training for four years and became a board-certified psychiatrist at the age of 38.

After serving as an Assistant Professor of Psychiatry for ten years at UCLA Medical School, Seager is currently employed at Napa State Hospital in Napa, California. Inspired by his time at Napa, Seager’s latest book, Behind the Gates of Gomorrah: A Year with the Criminally Insane, was released in September of 2014 by Simon and Schuster. Within its pages, Seager documents the harrowing life of a doctor in the violent, dangerous world of an American forensic mental hospital.

For more information about Seager and his books, visit

seagerStephenWhat was your upbringing like, and how did it shape who you are today?

I was born in Ogden, Utah. While Utah is the center of the Mormon Church, famous for 19th century polygamy and modern conservative politics, Ogden was not a church town, it was a railroad town; the Golden Spike — uniting the country’s first transcontinental railroad — was driven just north of there. My father was a physician and my mother, unusual for the times, got a business degree and, after a move to California when I was twelve, she became an administrator at San Francisco State College.

Among the values I learned as a child was the paramount importance of education and a love of reading. My childhood instilled in me a love of the written word and the first inklings that I might be able to write myself. At age eight, I produced my first poem, which was entitled “Ode to a Garbage Man” and began as follows: “He may not know a noun from a verb/ But he knows how to take a can from the curb…”

After your time working in the ER, what made you decide to switch to psychiatry?

My ER partners and I ran a level one trauma center in Phoenix, Arizona, in the 1980s. We cared for all the gunshot wounds, car accidents, stabbings and mayhem produced from a large urban American city. I would often attend to fifty injured patients in a single night. The stress simply became too much. One evening when I had five “code blues” — people in complete cardiac shut down — at the same time and I only had four breathing tubes, I realized I needed to do something else. My time in the ER did produce my first two books, Breathe, Little Boy, Breathe: An Emergency Room Doctor’s Story and Emergency!, a novel. But despite the ability to vent my feelings in my writing, the ER simply became too much to handle and psychiatry seemed like a safe place to land.

How did the opportunity to work at Napa State Hospital first come about? Were you fully aware of what you were getting yourself into when you accepted the position?

I had been a psychiatrist for over twenty years — including being an Assistant Professor of Psychiatry at UCLA medical school for eleven years — when my wife, also a physician, accepted a job in Northern California. I applied at Napa State Hospital simply because it was near to my wife’s work. I had no idea what working in a state mental hospital was going to be like. In fact, few people do. While largely ignored in the press, even among psychiatrists little is known about these places.

What motivates you to want to help people as much as you do, especially when it comes to those at Napa who may not necessarily want help?

Most of my patients do get better, or some better at least, and while it’s true that many don’t want help or believe they are mentally ill, it’s still satisfying. As a nurse says in the book, “It’s a Jesus job.” And she’s right. You do it for your own reasons, I guess.

What inspired you to write Behind the Gates of Gomorrah?

I wrote Behind the Gates of Gomorrah: A Year With the Criminally Insane becasue I was so shocked at the violence and terror that occured on a daily basis inside the hospital. I spoke to family and friends and no one knew such a place existed. I realized it was my patients who were receving most of the beatings — from other patients — but the staff, mainly female nurses, were being hit regularly as well. I wrote the book, finally, as an attempt to shed light on a terrible situation and to hopefully make the hospital a safer place for my patients.

What do you find most rewarding or enjoyable about your role at Napa State Hospital?

Working at Napa State has its rewards — most of my patients do get better or at least some better. I enjoy working with the professional, top-notch staff. But that is, in the end, overwhelmed by the constant danger and fear that Napa State generates.

What effect does constantly being exposed to violence and violent people have on your psyche? It must change your outlook on life at least somewhat, doesn’t it?

Being under constant stress and in perpetual danger has the same effect on the staff at Napa as being a policeman or soldier does. Working at Napa — and being a patient at Napa — produces the same problems — PTSD symptoms — that occur in any situation in which violence is a constant presence.

It doesn’t necessarily change my outlook on life. I’m an eternal optimist. And I’m optimistic that if enough people read Behind the Gates of Gomorrah and are moved to action, that some positive change may result in the lives of my patients and the rest of the Napa staff.

When faced with the sort of violence and stress that you’ve encountered, how often have you thought about simply walking away? Of getting in your car, driving away from Napa State Hospital and never coming back?

I think about walking away and driving home every day. But I haven’t yet.

Given your experiences, what changes would you make to the nation’s state hospital system and our approach to treating mental illness?

At Napa State, three things would change the situation a great deal.

1) We need a “Special Treatment Unit” where we could house the most violent offenders. Probably 80% of our assaults are perpetrated by 15% of the patients.

2) We need guards on the units. Fighting violent, psychotic psychopaths with tiny female nurses is a disaster.

3) Many of our patients come to Napa with a court decisions allowing them to decide for themselves if they want treatment or not. This makes little sense to me. Everyone given the option of treatment rather than prison should have to take the treatment. We need court-ordered medication on every patient.

This last problem is one of the main problems with the national approach to the treatment of mental illness and leads directly to the production of the homeless mentally ill and to the generation of school shooters. Treatment for mental illness is available but patients can refuse it.

What’s the best movie you’ve seen recently?

The best movie I’ve seen recently is Guardians of the Galaxy.

What’s your favorite type of sandwich?

My favorite sandwich, hands down, is the double cheeseburger, medium-rare, from Gott’s restaurant in downtown Napa. It costs 11 dollars and is worth every cent.

If you could take a few weeks and go anywhere in the world on vacation, where would you choose to go?

My best vacation would be to Tahiti or Fiji. My wife is a surfer and I’m learning, so we could do that every day. Those two places sound and look great. But I don’t like to fly, so probably, I’d end up going to Mendocino or Bodega Bay, two terrific beach towns near here.

Have you given any thought as to what your next book will be about?

The first draft of my next book is just done. If a sort-of sequel to Behind the Gates of Gomorrah called The Gods of Gomorrah. It’s a look at two hospital patients in depth and much more about me and what’s going on inside my head. I’m hoping for publication in 2016. By the way, you get a scoop: That’s the first time I’ve mentioned the title of my next book to anyone.


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