From the introduction:
The first rule is this: you’re not in charge anymore. Your life is gone, and you’re Insylum at the whim of the one who controls the world inside its walls: the Facilitator.
He dictates the course of events, establishes what and what is not real, and attempts to cure you. You have no choice but to follow. Everything Insylum is - the doctors and rooms and billy clubs - is the Facilitator. Nothing you do ever escapes his attentions.
Nothing you feel is secret.