The stressors on the staff and the patients in this environment include the criminal justice system, the custody staff, and limited resources from the department of psychiatry. The author reports four cases which illustrate the difficulty of merging the dual tasks of security and treatment in this unique setting. The staff may react to this dilemma and the stressors of the environment with treatment inflexibility, denial of psychopathology, polarization, and therapeutic nihilism. (Publisher abstract)