Menaker State Hospital is a curse, a refuge, a place of imprisonment, a necessity, a nightmare, a salvation.

When Dr. Lise Shields took a job at Menaker State Hospital five years ago, she was warned that many of the patients at the correctional psychiatric facility would never leave. This was where Maryland’s judicial system sent those who were either incompetent to stand trial or not responsible by reason of insanity. The residents have little hope for a normal life, and might never comprehend the brutality of the crimes they’ve committed.

But what happens when a place like Menaker becomes corrupted, when it becomes a tool to silence the innocent, to conceal an injustice, to contain a secret? Why is it that the newest patient does not seem to belong there, that the hospital administrator has fallen silent, and that Lise is being watched by two men with seemingly lethal intent? The answers are closer than she realizes and could cost her everything she holds dear.

In this chilling follow-up to The Absence of Mercy, author John Burley—a master at medical and psychological detail—showcases the many ways in which the dangers of the outside world pale in comparison to the horrors of the human mind.