Kaysen describes the interior ‘topography’ of McLean's Hospital. It had a prison-like atmosphere with locked entryway doors and a long hall that divided the ward into two: patient rooms on the left and nursing staff station on the right The ward also featured a chalkboard where patients signed in and out when they wanted to leave the ward and go elsewhere in the hospital if they were not deemed “restricted” to the ward by the nursing staff (47).

The ward included a seclusion room, which patients could request access to if they wanted to have a tantrum. However, most of the time the seclusion room was used by nursing staff to isolate a patient who was loud or disruptive. Kaysen points out that there were no “objective criteria” to determine if someone should be placed in the seclusion room, and when a patient remained noncompliant, they were moved to maximum security (48).

Kaysen questions why so many artists, writers, and musicians have stayed at McLean, and lists several notable people who received treatment there, including Sylvia Plath, Ray Charles, James Taylor, and Robert Lowell. The author wonders whether the hospital targeted artists, or if artists “specialized in madness?” (50).